title: The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry.
abstract: BACKGROUND
  In the literature, the 5 year survival rates for incidental gallbladder carcinoma (IGBC) show large variations in the different T-stages because the lymph node status often is not addressed. Most early-stage carcinomas are identified by laparoscopy as IGBC, and radical re-resection is needed. Staging is impossible without lymph node dissection, so comparison between various survival rates is impossible. This study aimed to determine the influence of lymph node status on the survival of patients with stages T1 to T3 IGBC.
  
  
  METHODS
  For data analysis, the German Registry was used.
  
  
  RESULTS
  In this study, 709 patients with IGBC were analyzed. The re-resected nodal-negative patients had a significant survival advantage over the re-resected nodal-positive patients. The 5 year survival rate for the patients with nodal-negative re-resected T1 carcinomas was 75%. The re-resected T2 and T3 nodal-negative patients had significantly better survival than the corresponding nodal-positive patients. The influence that the radicalness of the different liver resection techniques had on these results was excluded. 53 patients without radical resection had a known nodal-positive status. Nodal-positive patients with radical re-resection always show a better survival rate than nodal-positive patients without radical re-resection, stage for stage.
  
  
  CONCLUSIONS
  Nodal-positive status is a significant negative prognostic factor in T1 to T3 IGBC. Patients with radical re-resection show a better survival rate than those without it. Lymph node dissection is to be highly recommended up to stage T1b. In the case of T2 carcinomas, lymph node dissection of the hepatoduodenal ligament seems to be the minimum volume of lymph node dissection required, but more radical procedures could be beneficial for tumors infiltrating the serosa or beyond.
authors.affiliation: Department of Surgery, Ketteler-Krankenhaus, 63071, Offenbach, Germany. ThGoetze@aol.com
authors.forename: Thorsten Oliver
authors.initials: TO
authors.lastname: Goetze
authors.forename: Vittorio
authors.initials: V
authors.lastname: Paolucci
mesh_terms: D000368:Aged; D002763:Cholecystectomy / Q000379:methods* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000401:mortality; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012042:Registries; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome
references.citation: Am J Surg. 2007 Dec;194(6):820-5; discussion 825-6
references.pmid: 18005778
references.citation: Am J Surg. 1998 Feb;175(2):118-22
references.pmid: 9515527
references.citation: Eur J Surg Oncol. 2002 Feb;28(1):4-10
references.pmid: 11869005
references.citation: J Am Coll Surg. 2001 May;192(5):600-7
references.pmid: 11333097
references.citation: Surg Endosc. 2007 Sep;21(9):1582-7
references.pmid: 17479340
references.citation: Br J Surg. 2000 Apr;87(4):418-22
references.pmid: 10759735
references.citation: Surg Endosc. 2010 Sep;24(9):2156-64
references.pmid: 20177938
references.citation: J Gastrointest Surg. 2009 Apr;13(4):722-7
references.pmid: 19083068
references.citation: Surg Endosc. 2002 May;16(5):828-32
references.pmid: 11997831
references.citation: J Am Coll Surg. 1996 Oct;183(4):345-50
references.pmid: 8843263
references.citation: Ann Surg. 2007 Jun;245(6):893-901
references.pmid: 17522515
references.citation: Ann Surg. 1955 Jul;142(1):6-16
references.pmid: 14388606
references.citation: Ann Surg. 1996 Nov;224(5):639-46
references.pmid: 8916879
references.citation: Ann Surg. 2008 Jan;247(1):104-8
references.pmid: 18156929
references.citation: World J Surg. 2009 May;33(5):1035-41
references.pmid: 19225832
references.citation: Ann Surg. 2000 Oct;232(4):557-69
references.pmid: 10998654
references.citation: J Surg Oncol. 2008 May 1;97(6):498-502
references.pmid: 18314875
references.citation: Surg Radiol Anat. 1991;13(2):89-104
references.pmid: 1925922
references.citation: J Gastrointest Surg. 2007 Nov;11(11):1478-86; discussion 1486-7
references.pmid: 17846848
references.citation: Surgery. 2009 Oct;146(4):706-11; discussion 711-3
references.pmid: 19789030
references.citation: World J Surg. 1991 May-Jun;15(3):344-7
references.pmid: 1853613
references.citation: Ann Surg. 1992 Apr;215(4):326-31
references.pmid: 1558412
references.citation: Kurume Med J. 2001;48(4):267-71
references.pmid: 11830926
references.citation: Ann Surg. 2008 May;247(5):835-8
references.pmid: 18438121
references.citation: J Hepatobiliary Pancreat Surg. 2004;11(1):45-9
references.pmid: 15754046
references.citation: J Gastrointest Surg. 2009 Nov;13(11):2040-2
references.pmid: 19194769
references.citation: Am J Surg. 1992 Apr;163(4):382-6
references.pmid: 1558279
references.citation: Z Gastroenterol. 2007 Sep;45(9):971-1001
references.pmid: 17874360
references.citation: Arch Surg. 1990 Feb;125(2):237-41
references.pmid: 2302063
references.citation: J Natl Compr Canc Netw. 2009 Apr;7(4):350-91
references.pmid: 19406039
references.citation: Ann Surg. 1982 May;195(5):624-31
references.pmid: 7073360
references.citation: J Gastrointest Surg. 2007 Oct;11(10):1309-16
references.pmid: 17682825