TY - JOUR
T1 - Surgery in node-positive gallbladder cancer
T2 - The implication of an involved superior retro-pancreatic lymph node
AU - Chaudhary, Rahul K.
AU - Higuchi, Ryota
AU - Yazawa, Takehisa
AU - Uemura, Shuichiro
AU - Izumo, Wataru
AU - Furukawa, Toru
AU - Kiyohara, Kosuke
AU - Yamamoto, Masakazu
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/3
Y1 - 2019/3
N2 - Background: The treatment approach to node-positive gallbladder cancer has unresolved issues with regard to the management of patients with a positive superior retro-pancreatic (level 13a) node, which is the highest level of spread. The American Joint Committee on Cancer remains unclear on the status of the 13a node. Methods: This retrospective study consisted of 165 patients with node-positive gallbladder cancer without distant metastasis. Patients were reclassified according to the American Joint Committee on Cancer eighth edition classification. The survival of patients with positive level 13a node was compared with that of patients with N1 disease (T stage-wise) and those with para-aortic nodal disease. A multivariate analysis was performed for factors affecting survival. Results: The 5-year survival of patients with positive level 13a with 1–3 nodes was similar to those with N1 disease (40.2% and 32.9%, respectively) and was better than those with more distant nodal spread (P <.05). In univariate and multivariate analyses, intraoperative blood loss (hazard ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients. Conclusion: A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and should be treated as such.
AB - Background: The treatment approach to node-positive gallbladder cancer has unresolved issues with regard to the management of patients with a positive superior retro-pancreatic (level 13a) node, which is the highest level of spread. The American Joint Committee on Cancer remains unclear on the status of the 13a node. Methods: This retrospective study consisted of 165 patients with node-positive gallbladder cancer without distant metastasis. Patients were reclassified according to the American Joint Committee on Cancer eighth edition classification. The survival of patients with positive level 13a node was compared with that of patients with N1 disease (T stage-wise) and those with para-aortic nodal disease. A multivariate analysis was performed for factors affecting survival. Results: The 5-year survival of patients with positive level 13a with 1–3 nodes was similar to those with N1 disease (40.2% and 32.9%, respectively) and was better than those with more distant nodal spread (P <.05). In univariate and multivariate analyses, intraoperative blood loss (hazard ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients. Conclusion: A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and should be treated as such.
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U2 - 10.1016/j.surg.2018.09.003
DO - 10.1016/j.surg.2018.09.003
M3 - Article
C2 - 30348459
AN - SCOPUS:85055018161
VL - 165
SP - 541
EP - 547
JO - Surgery (United States)
JF - Surgery (United States)
SN - 0039-6060
IS - 3
ER -