Surgico-pathological Outcomes of 148 Radical Cholecystectomies Using Systematic Regional Lymphadenectomy Protocol: a Retrospective Study

Excerpt

Gallbladder cancer (GBC) is a potentially lethal malignancy among the biliary tract cancers with abysmal long-term survival. Surgery is the only curative treatment available for the management of GBC and, presently, provides the only ray of hope for long-term survival [1, 2]. Lymph node (LN) involvement is an important prognostic factor in GBC; lymphadenectomy is an indispensable part of radical resection [3]. American Joint Committee on Cancer 7th edition TNM staging for gallbladder cancer describes N1 nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein and N2 nodes as periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes [4]. AJCC staging manual further stages the presence of N2 nodes as stage IV disease; this nihilism has given rise to a marked controversy in the role and extent of lymphadenectomy. Though a number of studies have highlighted that the lymphadenectomy is associated with improved survival after surgery in GBC [5‐7], literature is still not clear whether the total number of LNs retrieved, number of metastatic LNs, or their ratio or the location of LNs correlates with survival [8]. We believe that a systematic approach to regional lymphadenectomy is essential to maximize the lymph node yield based on the sound principles of surgical oncology. The present study shares our experience of radical cholecystectomies using a systematic regional lymphadenectomy protocol in a large cohort of patients with GBC. …