Abstract
Background
This study was designed to compare the prognostic power of the location of positive lymph nodes with that of the number of positive lymph nodes in gallbladder carcinoma.
Methods
A retrospective analysis was conducted of 116 consecutive patients who underwent an R0 radical resection for gallbladder carcinoma. A total of 2,406 lymph nodes taken from the patients were examined histologically. The location of positive regional nodes was classified according to the Japanese staging system. The number of positive regional nodes was recorded for each patient.
Results
Nodal disease was found in 49 patients, of whom 19 survived for more than 5 years after resection. Univariate analysis revealed that both the location (P < 0.0001) and the number (P < 0.0001) of positive nodes were significant prognostic factors. Multivariate analysis revealed that the number of positive nodes was an independent prognostic factor (P < 0.001), whereas the location of positive nodes failed to remain as an independent variable. The cumulative 5-year survival rates were 81% for patients without regional nodal disease, 62% for patients with a single positive node, 43% for patients with 2–3 positive nodes, and 15% for patients with ≥4 positive nodes (P < 0.0001).
Conclusions
The number, not the location, of positive lymph nodes independently determines the prognosis after resection in gallbladder carcinoma. No nodal disease or a single positive node indicates a favorable outcome after resection, whereas radical lymph node dissection is effective for selected patients with multiple positive nodes, provided that an R0 resection is feasible.
Similar content being viewed by others
References
Greene FL, Page DL, Fleming ID, et al., editors. American Joint Committee on Cancer Staging Manual. 6th ed. New York: Springer; 2002. p. 139–44.
Nagakawa T, Hirata K, Ikeda S, et al., editors. Classification of biliary tract carcinoma. Japanese Society of Biliary Surgery (JSBS). 2nd English ed. Tokyo: Kanehara; 2004. p. 33–50.
Shirai Y, Wakai T, Hatakeyama K. Radical lymph node dissection for gallbladder cancer: indications and limitations. Surg Oncol Clin N Am. 2007;16:221–32.
Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H. Radical surgery for gallbladder carcinoma: long-term results. Ann Surg. 1992;216:565–8.
Chijiiwa K, Tanaka M. Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery. 1994;115:751–6.
Miyazaki M, Itoh H, Ambiru S, et al. Radical surgery for advanced gallbladder carcinoma. Br J Surg. 1996;83:478–81.
Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer. 1997;80:661–7.
Shirai Y, Ohtani T, Tsukada K, Hatakeyama K. Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long-term results. Cancer. 1997;80:1904–9.
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;87:418–22.
Araida T, Yoshikawa T, Azuma T, Ota T, Takasaki K, Hanyu F. Indications for pancreatoduodenectomy in patients undergoing lymphadenectomy for advanced gallbladder carcinoma. J Hepatobiliary Pancreat Surg. 2004;11:45–9.
Endo I, Shimada H, Tanabe M, et al. Prognostic significance of the number of positive lymph nodes in gallbladder cancer. J Gastrointest Surg. 2006;10:999–1007.
Sasaki R, Itabashi H, Fujita T, et al. Significance of extensive surgery including resection of the pancreas head for the treatment of gallbladder cancer–from the perspective of mode of lymph node involvement and surgical outcome. World J Surg. 2006;30:36–42.
Yokomizo H, Yamane T, Hirata T, Hifumi M, Kawaguchi T, Fukuda S. Surgical treatment of pT2 gallbladder carcinoma: a reevaluation of the therapeutic effect of hepatectomy and extrahepatic bile duct resection based on the long-term outcome. Ann Surg Oncol. 2007;14:1366–73.
Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA. Carcinoma of the gallbladder. Does radical resection improve outcome? Arch Surg. 1990;125:237–41.
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;175:118–22.
Behari A, Sikora SS, Wagholikar GD, Kumar A, Saxena R, Kapoor VK. Longterm survival after extended resections in patients with gallbladder cancer. J Am Coll Surg. 2003;196:82–8.
Pitt HA. Gallbladder cancer: what is an aggressive approach? Ann Surg. 2005;241:395–6.
Paquet KJ. Appraisal of surgical resection of gallbladder carcinoma with special reference to hepatic resection. J Hepatobiliary Pancreat Surg. 1998;5:200–6.
Muratore A, Polastri R, Bouzari H, Vergara V, Capussotti L. Radical surgery for gallbladder cancer: a worthwhile operation? Eur J Surg Oncol. 2000;26:160–3.
Wise PE, Shi YY, Washington MK, Chapman WC, Wright JK, Sharp KW, Pinson CW. Radical resection improves survival for patients with pT2 gallbladder carcinoma. Am Surg. 2001;67:1041–7.
Reddy SK, Marroquin CE, Kuo PC, Pappas TN, Clary BM. Extended hepatic resection for gallbladder cancer. Am J Surg. 2007;194:355–61.
Foster JM, Hoshi H, Gibbs JF, Iyer R, Javle M, Chu Q, Kuvshinoff B. Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol. 2007;14:833–40.
D’Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009;16:806–16.
Cohen AM, Tremiterra S, Candela F, Thaler HT, Sigurdson ER. Prognosis of node-positive colon cancer. Cancer. 1991;67:1859–61.
Kodera Y, Yamamura Y, Shimizu Y, et al. The number of metastatic lymph nodes: a promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification. J Am Coll Surg. 1998;187:597–603.
Shirai Y, Yoshida K, Tsukada K, Muto T. Inapparent carcinoma of the gallbladder: an appraisal of a radical second operation after simple cholecystectomy. Ann Surg. 1992;215:326–31.
Tsukada K, Hatakeyama K, Kurosaki I, Uchida K, Shirai Y, Muto T, Yoshida K. Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery. 1996;120:816–22.
Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H. Early carcinoma of the gallbladder. Eur J Surg. 1992;158:545–8.
Wakai T, Shirai Y, Yokoyama N, Nagakura S, Watanabe H, Hatakeyama K. Early gallbladder carcinoma does not warrant radical resection. Br J Surg. 2001;88:675–8.
Fahim RB, McDonald JR, Richards JC, Ferris DO. Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg. 1962;156:114–24.
Shirai Y, Yoshida K, Tsukada K, Ohtani T, Muto T. Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg. 1992;79:659–62.
Sakata J, Shirai Y, Wakai T, Yokoyama N, Sakata E, Akazawa K, Hatakeyama K. Number of positive lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma. Eur J Surg Oncol. 2007;33:346–51.
Yokoyama N, Shirai Y, Hatakeyama K. Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody. Cancer. 1999;85:1465–9.
Nagakura S, Shirai Y, Yokoyama N, Hatakeyama K. Clinical significance of lymph node micrometastasis in gallbladder carcinoma. Surgery. 2001;129:704–13.
Sasaki E, Nagino M, Ebata T, Oda K, Arai T, Nishio H, Nimura Y. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma. Ann Surg. 2006;244:99–105.
Glenn F, Hays DM. The scope of radical surgery in the treatment of malignant tumors of the extrahepatic biliary tract. Surg Gynecol Obstet. 1954;99:529–41.
Kondo S, Nimura Y, Kamiya J, et al. Five-year survivors after aggressive surgery for stage IV gallbladder cancer. J Hepatobiliary Pancreat Surg. 2001;8:511–7.
Ota T, Araida T, Tanizawa T, et al. Clinical characteristics of the long-term survival cases of surgically treated gallbladder carcinoma with lymph node metastasis: especially for the appropriate operation method (in Japanese). Tan to Sui. 2006;27:655–9.
Doty JR, Cameron JL, Yeo CJ, Campbell K, Coleman J, Hruban RH. Cholecystectomy, liver resection, and pylorus-preserving pancreaticoduodenectomy for gallbladder cancer: report of five cases. J Gastrointest Surg. 2002;6:776–80.
Sakata J, Shirai Y, Wakai T, Kaneko K, Nagahashi M, Hatakeyama K. Radical resection for adenosquamous carcinoma of the gallbladder with paraaortic lymph node metastasis: report of a 5-year survivor (in Japanese with English abstract). Jpn J Gastroenterol Surg. 2007;40:1816–21.
Ueda N, Kimura T, Sawa T. Significance and problems of dissection for lymph node metastasis and invasion to hepatoduodenal ligament of advanced gallbladder cancer (in Japanese with English abstract). Tando. 2008;22:154–9.
Amemiya T, Yokoyama Y, Oda K, et al. A patient with gallbladder cancer with paraaortic lymph node and hepatic metastases who has survived for more than 13 years after the primary extended radical operation. J Hepatobiliary Pancreat Surg. 2008;15:648–51.
Muratore A, Polastri R, Capussotti L. Radical surgery for gallbladder cancer: current options. Eur J Surg Oncol. 2000;26:438–43.
Kim ST, Park JO, Lee J, et al. A phase II study of gemcitabine and cisplatin in advanced biliary tract cancer. Cancer. 2006;106:1339–46.
Iyer RV, Gibbs J, Kuvshinoff B, et al. A phase II study of gemcitabine and capecitabine in advanced cholangiocarcinoma and carcinoma of the gallbladder: a single-institution prospective study. Ann Surg Oncol. 2007;14:3202–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sakata, J., Shirai, Y., Wakai, T. et al. Number of Positive Lymph Nodes Independently Determines the Prognosis After Resection in Patients with Gallbladder Carcinoma. Ann Surg Oncol 17, 1831–1840 (2010). https://doi.org/10.1245/s10434-009-0899-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0899-1