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Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus indicates whether an oncologic extended resection (OER) is required.

Methods

The study included patients who underwent OER for incidental gallbladder cancer (IGBC) during 1999–2015. Associations between a positive cystic duct node and D2 nodal status and disease-specific survival (DSS) were analyzed.

Results

One-hundred-eight-seven patients were included. Seventy-three patients (39%) had the incidental cystic duct node retrieved. Cystic duct node positivity was associated with positive D1 (odds ratio 5.2, p = 0.012) but not with D2. Among all patients, a positive cystic duct node was associated with worse DSS (hazard ratio [HR] 2.09). Patients without residual cancer at OER and positive incidental cystic duct node had similar DSS to patients with negative nodes 70 vs 60% (p = 0.337). Positive D1 (HR 6.07) or positive D2 (HR 13.8) was predictive of worse DSS.

Conclusions

Patients with no residual cancer at OER and regional disease limited to their incidental cystic duct node have similar DSS to pN0 patients. The status of the cystic duct node only predicts the status of hepatic pedicle nodes.

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References

  1. Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol 2003;4(3):167–76.

    Article  PubMed  Google Scholar 

  2. Benoist S, Panis Y, Fagniez PL. Long-term results after curative resection for carcinoma of the gallbladder. French University Association for Surgical Research. Am J Surg 1998;175(2):118–22.

    Article  CAS  PubMed  Google Scholar 

  3. Henley SJ, Weir HK, Jim MA, Watson M, Richardson LC. Gallbladder cancer incidence and mortality, United States 1999–2011. Cancer Epidemiol Biomarkers Prev 2015;24(9):1319–26.

    Article  PubMed  Google Scholar 

  4. Kohya N, Miyazaki K. Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol 2008;97(6):498–502.

    Article  PubMed  Google Scholar 

  5. Shih SP, Schulick RD, Cameron JL, Lillemoe KD, Pitt HA, Choti MA, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2007;245(6):893–901.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pitt SC, Jin LX, Hall BL, Strasberg SM, Pitt HA. Incidental gallbladder cancer at cholecystectomy: when should the surgeon be suspicious? Ann Surg 2014;260(1):128–33.

    Article  PubMed  Google Scholar 

  7. Vinuela E, Vega EA, Yamashita S, Sanhueza M, Mege R, Cavada G et al. Incidental gallbladder cancer: residual cancer discovered at oncologic extended resection determines outcome: a report from high- and low-incidence countries. Ann Surg Oncol 2017. doi:10.1245/s10434-017-5859-6. Author names in bold designate shared co-first authorship

  8. Tsukada K, Kurosaki I, Uchida K, Shirai Y, Oohashi Y, Yokoyama N, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80(4):661–7.

    Article  CAS  PubMed  Google Scholar 

  9. Fahim RB, Mc DJ, Richards JC, Ferris DO. Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg 1962;156:114–24..

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Shimada H, Endo I, Togo S, Nakano A, Izumi T, Nakagawara G. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 1997;79(5):892–9.

    Article  CAS  PubMed  Google Scholar 

  11. Kokudo N, Makuuchi M, Natori T, Sakamoto Y, Yamamoto J, Seki M, et al. Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 2003;138(7):741–50; discussion 50.

    Article  PubMed  Google Scholar 

  12. Benson AB, 3rd, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 2009;7(4):350–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Vega EA, Yamashita S, Chun YS, Kim M, Fleming JB, Katz MH et al. Effective laparoscopic management lymph node dissection for gallbladder cancer. Ann Surgical Oncol 2017. doi:10.1245/s10434-017-5773-y.

  14. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma 2nd English Edition. Gastric Cancer 1998;1(1):10–24.

  15. Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Ohtsuka M. General remarks on general rules for surgical and pathological studies on cancer of the biliary tract. Nihon Rinsho 2006;64 Suppl 1:385–8.

    PubMed  Google Scholar 

  16. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  18. Mise Y, Vauthey JN, Zimmitti G, Parker NH, Conrad C, Aloia TA, et al. Ninety-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality. Ann Surg 2015;262(6):1071–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Amini N, Kim Y, Wilson A, Margonis GA, Ethun CG, Poultsides G, et al. Prognostic implications of lymph node status for patients with gallbladder cancer: a multi-institutional study. Ann Surg Oncol 2016;23(9):3016–23.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ito H, Ito K, D'Angelica M, Gonen M, Klimstra D, Allen P, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg 2011;254(2):320–5.

    Article  PubMed  Google Scholar 

  21. Birnbaum DJ, Vigano L, Russolillo N, Langella S, Ferrero A, Capussotti L. Lymph node metastases in patients undergoing surgery for a gallbladder cancer. Extension of the lymph node dissection and prognostic value of the lymph node ratio. Ann Surg Oncol 2015;22(3):811–8.

    Article  PubMed  Google Scholar 

  22. Kim SH, Chong JU, Lim JH, Choi GH, Kang CM, Choi JS, et al. Optimal assessment of lymph node status in gallbladder cancer. Eur J Surg Oncol 2016;42(2):205–10.

    Article  CAS  PubMed  Google Scholar 

  23. Negi SS, Singh A, Chaudhary A. Lymph nodal involvement as prognostic factor in gallbladder cancer: location, count or ratio? J Gastrointest Surg 2011;15(6):1017–25.

    Article  PubMed  Google Scholar 

  24. Shirai Y, Wakai T, Sakata J, Hatakeyama K. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol 2012;18(22):2775–83

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sakata J, Shirai Y, Wakai T, Ajioka Y, Hatakeyama K. Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma. Ann Surg Oncol 2010;17(7):1831–40.

    Article  PubMed  Google Scholar 

  26. Endo I, Shimada H, Tanabe M, Fujii Y, Takeda K, Morioka D, et al. Prognostic significance of the number of positive lymph nodes in gallbladder cancer. J Gastrointest Surg 2006;10(7):999–1007.

    Article  PubMed  Google Scholar 

  27. Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg 2000;87(4):418–22.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The University of Texas MD Anderson Cancer Center is supported in part by the NIH/NCI under award number P30CA016672.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA

    Eduardo A. Vega, Suguru Yamashita, Thomas A. Aloia, Yun Shin Chun, Ching-Wei D Tzeng, Masayuki Okuno, Claire Goumard, Jean-Nicolas Vauthey, Jeffrey E. Lee & Claudius Conrad

  2. Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile

    Eduardo A. Vega, Eduardo Vinuela, Marcel Sanhueza & Cristian Diaz

  3. Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile

    Eduardo Vinuela, Marcel Sanhueza & Cristian Diaz

  4. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Suguru Yamashita

  5. Department of Epidemiology, Faculty of Medicine and Public Health School, University of Los Andes Santiago, Santiago, Chile

    Gabriel Cavada

Authors
  1. Eduardo A. Vega
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  2. Eduardo Vinuela
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  3. Suguru Yamashita
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  4. Marcel Sanhueza
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  5. Gabriel Cavada
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  6. Cristian Diaz
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  7. Thomas A. Aloia
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  8. Yun Shin Chun
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  9. Ching-Wei D Tzeng
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  10. Masayuki Okuno
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  11. Claire Goumard
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  12. Jean-Nicolas Vauthey
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  13. Jeffrey E. Lee
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  14. Claudius Conrad
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Contributions

All authors meet the following criteria:

1. Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work.

Vega, Vinuela, Yamashita, Sanhueza, Cavada, Diaz, Aloia, Chun, Tzeng, Okuno, Goumard, Vauthey, Lee, and Conrad.

2. Drafting the work or revising it critically for important intellectual content.

Vega, Vinuela, Yamashita, Sanhueza, Cavada, Diaz, Aloia, Chun, Tzeng, Okuno, Goumard, Vauthey, Lee, and Conrad.

3. Final approval of the version to be published.

Vega, Vinuela, Yamashita, Sanhueza, Cavada, Diaz, Aloia, Chun, Tzeng, Okuno, Goumard, Vauthey, Lee, and Conrad.

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Vega, Vinuela, Yamashita, Sanhueza, Cavada, Diaz, Aloia, Chun, Tzeng, Okuno, Goumard, Vauthey, Lee, and Conrad.

Corresponding author

Correspondence to Claudius Conrad.

Ethics declarations

This study was approved by the institutional review boards of both hospitals.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Oral presentation: 58th SSAT Annual Meeting 2017 in Chicago

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Vega, E.A., Vinuela, E., Yamashita, S. et al. Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status. J Gastrointest Surg 22, 43–51 (2018). https://doi.org/10.1007/s11605-017-3507-x

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  • DOI: https://doi.org/10.1007/s11605-017-3507-x

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