Retroperitoneal Lymph Node Metastasis in Gallbladder Cancer: As Bad as Distant Metastasis

Abstract

Ashish Singh

Background Regarding gallbladder cancer (GBC) there is conflicting evidence in the literature whether retroperitoneal lymph nodal metastases (RLNM) should be considered as regional nodal metastasis or as distant metastasis (DM) and the jury is out on radical curative surgery in presence of RLNM. This is an analysis of GBC patients, to see the effect of RLNM on survival and to compare with that of patients with DMs.

Methods A retrospective analysis of a prospective database of patients of GBC with RLNM (interaortocaval and paraaortic) or DM on frozen section biopsy at surgery, between January 2013 and December 2018. Data was analyzed using the Statistical Package for the Social Sciences software (version 22.0). Survival in these two groups (RLNM and DM) was compared with log-rank test. A p-value of < 0.05 was considered significant.

Results A total of 235 patients with ostensibly resectable GBC underwent surgical exploration. The planned curative resection was abandoned in 91 (39%) patients because of RLNM (n = 20, 9%) or DM (n = 71, 30%) on frozen section biopsy. Demographic profile and blood parameters were similar. The median survival for RLNM and DM groups were 5 (range 2–26) and 6 (range 2–24) months, respectively, with no significant difference on log-rank test (p = 0.64). There was no 3-year or longer survivor in either group.

Conclusion Due to similar poor survival in presence of RLNM or DM, RLNM should be considered as the equivalent of DM. This study strengthens evidence to avoid curative surgery in patients with RLNM. These lymph nodes should be sampled preoperatively, if suspicious on imaging, for fine-needle aspiration cytology and at surgery, as a routine for frozen section histological examination before initiating curative resection to avert a futile exercise.

Keywords

gallbladder cancer - retroperitoneal lymph node metastasis - interaortocaval lymph node metastasis - para-aortic lymph-node metastasis - distant metastasis

Authors' Contributions

Conception and design: A.S., N.K.G., R.S., V.K.K.

Administrative support: V.K.K., R.S.

Provision of study materials or patients: R.S., V.K.K.

Collection and assembly of data: All authors.

Data analysis and interpretation: A.S., N.K.G., Rahul.

Manuscript writing: All authors.

Final approval of manuscript: All authors.

Ethical Statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethical Approval

It was a retrospective analysis of prospective database so no ethical clearance was sought.

Publikationsverlauf

Artikel online veröffentlicht:
22. März 2022

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