Skip to main content

Relevance of Dissection of the Posterior Superior Pancreaticoduodenal Lymph Nodes in Gallbladder Carcinoma

Annals of Surgical Oncology volume 24, pages 2474–2481 (2017)Cite this article

Abstract

Background

This study was designed to evaluate the prognostic value of positive posterior superior pancreaticoduodenal lymph nodes to clarify the need for dissection of these nodes.

Methods

A total of 148 patients with gallbladder carcinoma who underwent radical resection including dissection of the posterior superior pancreaticoduodenal nodes were enrolled. The incidence of metastasis and the survival rates among patients with metastasis to each lymph node group were calculated.

Results

Of the 148 patients, 70 (47%) had nodal disease. The incidences of metastasis in the cystic duct, pericholedochal, retroportal, and hepatic artery node groups, defined as regional nodes in the UICC TNM staging system, ranged from 8.3 to 24.3% with 5-year survival rates of 12.5–46.4% in patients with positive nodes. The incidence of metastasis to the posterior superior pancreaticoduodenal nodes was 12.8% with a 5-year survival rate of 31.6% in patients with positive nodes. Survival after resection was significantly better in patients with distant nodal disease affecting only the posterior superior pancreaticoduodenal nodes (5-year survival, 55.6%) than in patients with distant nodal disease beyond these nodes (5-year survival, 15.0%; p = 0.046), whereas survival after resection was comparable between the former group and patients with regional nodal disease alone (5-year survival, 40.7%; p = 0.426).

Conclusions

In gallbladder carcinoma, involvement of the posterior superior pancreaticoduodenal nodes is similar to that of regional nodes in terms of both the incidence of metastasis and the impact on survival. Inclusion of the posterior superior pancreaticoduodenal nodes among the regional nodes should be considered.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. 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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000;232:557–69.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 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.

    CAS  Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumours, 7th edn. New York: Wiley-Blackwell; 2010.

    Google Scholar 

  6. 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.

    CAS  Article  PubMed  Google Scholar 

  7. Behari A, Sikora SS, Wagholikar GD, Kumar A, Saxena R, Kapoor VK. Long-term survival after extended resections in patients with gallbladder cancer. J Am Coll Surg. 2003;196:82–8.

    Article  PubMed  Google Scholar 

  8. Ito H, Ito K, D’Angelica M, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254:320–5.

    Article  PubMed  Google Scholar 

  9. Coburn NG, Cleary SP, Tan JC, Law CH. Surgery for gallbladder cancer: a population-based analysis. J Am Coll Surg. 2008;207:371–82.

    Article  PubMed  Google Scholar 

  10. Ito M, Mishima Y, Sato T. An anatomical study of the lymphatic drainage of the gallbladder. Surg Radiol Anat. 1991;13:89–104.

    CAS  Article  PubMed  Google Scholar 

  11. 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.

    CAS  Article  PubMed  Google Scholar 

  12. Uesaka K, Yasui K, Morimoto T, et al. Visualization of routes of lymphatic drainage of the gallbladder with a carbon particle suspension. J Am Coll Surg. 1996;183:345–50.

    CAS  PubMed  Google Scholar 

  13. Kishi Y, Shimada K, Hata S, et al. Definition of T3/4 and regional lymph nodes in gallbladder cancer: which is more valid, the UICC or the Japanese staging system? Ann Surg Oncol. 2014;21:2882–8.

    Article  PubMed  Google Scholar 

  14. Higuchi R, Ota T, Araida T, et al. Surgical approaches to advanced gallbladder cancer: a 40-year single-institution study of prognostic factors and resectability. Ann Surg Oncol. 2014;21:4308–16.

    Article  PubMed  Google Scholar 

  15. Ishihara S, Horiguchi A, Miyakawa S, Endo I, Miyazaki M, Takada T. Biliary tract cancer registry in Japan from 2008 to 2013. J Hepatobiliary Pancreat Sci. 2016;23:149–57.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Birnbaum DJ, Viganò 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;22:811–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shirai Y, Sakata J, Wakai T, Ohashi T, Hatakeyama K. “Extended” radical cholecystectomy for gallbladder cancer: long-term outcomes, indications and limitations. World J Gastroenterol. 2012;18:4736–43.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wakai T, Shirai Y, Sakata J, Nagahashi M, Ajioka Y, Hatakeyama K. Mode of hepatic spread from gallbladder carcinoma: an immunohistochemical analysis of 42 hepatectomized specimens. Am J Surg Pathol. 2010;34:65–74.

    Article  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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;79:892–9.

    CAS  Article  PubMed  Google Scholar 

  23. Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer. 1997;80:661–7.

    CAS  Article  PubMed  Google Scholar 

  24. Downing SR, Cadogan KA, Ortega G, et al. Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection. Arch Surg. 2011;146:734–8.

    Article  PubMed  Google Scholar 

  25. Pawlik TM, Gleisner AL, Vigano L, et al. Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg. 2007;11:1478–86.

    Article  PubMed  Google Scholar 

  26. Wang J, Kulaylat M, Rockette H, Hassett J, Rajput A, Dunn KB, Dayton M. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg. 2009;249:559–63.

    Article  PubMed  Google Scholar 

  27. Kim YW, Kim NK, Min BS, Lee KY, Sohn SK, Cho CH. The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumor-specific mesorectal excision. Ann Surg. 2009;249:965–72.

    Article  PubMed  Google Scholar 

  28. Nishio H, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Gallbladder cancer involving the extrahepatic bile duct is worthy of resection. Ann Surg. 2011;253:953–60.

    Article  PubMed  Google Scholar 

  29. Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T, Hiraoka N. Extended right hemihepatectomy for gallbladder carcinoma involving the hepatic hilum. Br J Surg. 2011;98:117–23.

    CAS  Article  PubMed  Google Scholar 

Download references

Disclosure

The authors have no conflicts of interest to disclose.

Author information

Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan

    Jun Sakata MD, Takashi Kobayashi MD, Yosuke Tajima MD, Taku Ohashi MD, Yuki Hirose MD, Kabuto Takano MD, Kazuyasu Takizawa MD, Kohei Miura MD & Toshifumi Wakai MD, FACS

Authors
  1. Jun Sakata MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Kobayashi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yosuke Tajima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taku Ohashi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuki Hirose MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kabuto Takano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuyasu Takizawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kohei Miura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshifumi Wakai MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun Sakata MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 37 kb)

Supplementary material 2 (TIFF 5024 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sakata, J., Kobayashi, T., Tajima, Y. et al. Relevance of Dissection of the Posterior Superior Pancreaticoduodenal Lymph Nodes in Gallbladder Carcinoma. Ann Surg Oncol 24, 2474–2481 (2017). https://doi.org/10.1245/s10434-017-5939-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-5939-7

Keywords

  • Posterior Superior Pancreaticoduodenal
  • Gallbladder Carcinoma
  • Distant Nodal Disease
  • Common Hepatic Artery Nodes
  • Node Groups