Regional lymphadenectomy for gallbladder cancer: Rational extent, technical details, and patient outcomes

Table 1 Radical resection procedures for 152 patients with gallbladder cancer

Procedure	No. of patients
Extended cholecystectomy (n = 93)
C + WR + BD + N1	54
C + WR + N	21
C2 + BD + N	12
C2 + N	6
More extensive resection (n = 59)
C + ERH + BD + N	27
C + Central hepatectomy3 + BD + N	3
C + Extended left hepatectomy4 + BD + N	1
C + Right trisectionectomy + BD + N	1
C + WR + PD + N	15
C + ERH + PD + N	7
C + ERH + PPPD + N	3
C2 + PD + N	2

¹Designated as “extended” radical cholecystectomy (modified Glenn operation) at our department since 1982;

²Cholecystectomy with full-thickness dissection: cholecystectomy combined with removal of the cystic plate;

³Resection of Couinaud segments IV, V, and VIII;

⁴Left hemihepatectomy extended to an inferior portion of the right anterior section. C: Cholecystectomy; WR: Wedge resection of the gallbladder fossa; BD: Bile duct resection; N: Regional lymphadenectomy; ERH: Extended right hepatectomy (right hemihepatectomy extended to an inferior portion of Couinaud segment 4); PD: Whipple pancreaticoduodenectomy; PPPD: Pylorus-preserving pancreaticoduodenectomy.

Table 2 Topographical distribution of 3352 lymph nodes evaluated in 152 patients with gallbladder cancer

Node group	No. of patients with node group evaluated	No. of lymphnodes evaluated		No. of patients with positive nodes	No. ofpositive nodes
		Range per patient (median)	Total		Range per patient (median)	Total
First-echelon node groups
Pericholedochal1	152	0-9 (2)	410	43	1-9 (1)	75
Cystic duct	152	0-2 (1)	109	30	1-2 (1)	33
Second-echelon node groups
Retroportal	152	0-9 (3)	458	23	1-5 (2)	47
Posterior superior pancreaticoduodenal2	150	0-9 (2)	341	20	1-7 (1)	37
Hepatic artery	148	0-12 (3)	536	20	1-10 (1)	50
Right celiac3	128	0-8 (2)	320	15	1-4 (1)	28
Hilar (porta hepatis)	121	0-5 (0)	37	0	NA	0
More distant node groups
Superior mesenteric	50	0-14 (2)	171	4	1-5 (2)	10
Posterior inferior pancreaticoduodenal	38	0-7 (1)	56	3	1-5 (2)	8
Anterior superior pancreaticoduodenal	29	0-5 (0)	19	1	1-1 (1)	1
Anterior inferior pancreaticoduodenal	27	0-4 (0)	15	2	1-3 (2)	4
Perigastric	52	0-23 (2)	205	4	1-1 (1)	4
Paraaortic node groups	934	1-28 (6)	675	15	1-16 (2)	59

¹Also referred to as retroduodenal nodes in the NCCN guidelines[11];

²Also referred to as posterosuperior pancreaticoduodenal nodes in our previous study[6] or superior retropancreaticoduodenal nodes by Uesaka et al[22];

³Also referred to as posterior common hepatic nodes by Uesaka et al[22];

⁴Includes 55 who underwent a paraaortic lymph node dissection and 38 who underwent a sampling of paraaortic nodes for staging of the disease.

Table 3 Site of nodal involvement in 27 patients with a single positive node

Node group involved	No. of patients
Cystic duct	11
Pericholedochal	9
Posterior superior pancreaticoduodenal	3
Retroportal	2
Hepatic artery	1
Paraaortic	1

Table 4 Five-year survivors with nodal disease according to type of regional lymphadenectomy

No. of positive nodes	No. of 5-year survivors
	Extended portal LND	Peripancreatic (head only) LND with PD	Total
1	12	1	13
2-3	4	1	5
≥ 4	1	3	4

LND: Lymph node dissection; PD: Pancreaticoduodenectomy (Whipple procedure or pylorus-preserving procedure).