Surgery for gallbladder cancer in the US: a need for greater lymph node clearance.
BACKGROUND
Gallbladder cancer (GBC) is a rare malignancy with a dismal prognosis. Often identified incidentally after laparoscopic cholecystectomy for presumably benign biliary disease, reoperation with partial hepatic resection and periportal lymph node dissection (LND) is frequently performed. The impact of lymph node (LN) clearance for GBC remains unclear.


METHODS
The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients diagnosed with GBC between 1988 and 2009. Survival was calculated using Kaplan-Meier method and compared using log-rank test. Multivariate analysis was performed to identify predictors of survival.


RESULTS
A total of 11,815 patients diagnosed with GBC were identified. Cancer-directed surgery was performed in 8,436 (71.3%) patients. Optimal LN clearance (defined as ≥4 LNs) is associated with young age, advanced T-stage, no radiation therapy, and radical surgery (all <0.001). Greater LND improves survival for all stages (P<0.001). After adjusting for confounding factors, multivariable analysis of patients with node-negative disease demonstrated that early stage, greater LND, and radical surgery were strong independent predictors of survival.


CONCLUSIONS
Extensive lymphadenectomy correlates with longer survival even in node negative patients. Extensive LND should be performed in patients with GBC as many patients in the USA are undertreated.
1 Department of Surgery, Stanford University, Stanford, CA, USA ; 2 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Thuy B
TB
Tran
1 Department of Surgery, Stanford University, Stanford, CA, USA ; 2 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Nicholas N
NN
Nissen
Gallbladder cancer (GBC); lymph node dissection (LND); lymphadenectomy; the Surveillance, Epidemiology, and End Results (SEER)