Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma

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Abstract
Background: There have been no reports on the routine use of regional and para-aortic lymphadenectomy for gallbladder cancer. The aim of this study was to elucidate nodal status, its prognostic influence and the efficacy of lymphadenectomy. Methods: A retrospective analysis was made of 60 patients who underwent radical resection and routine regional and para-aortic lymphadenectomy. Results: Of the 60 patients, 73 per cent had node-positive disease and 38 per cent had positive para-aortic nodes. Postoperative survival was extremely poor in patients with minimal distant metastasis, and similarly in patients with para-aortic disease. The survival of patients with metastasis limited to the regional nodes was significantly better than that of those with distant metastasis (P = 0·029) or para-aortic disease (P = 0·017) and was not significantly different from that of patients with no metastasis (P = 0·82). Conclusion: Regional and para-aortic lymphadenectomy provides no survival benefit for patients with para-aortic disease, which has an influence on poor prognosis equivalent to that of distant metastasis. It has the potential to bring survival benefit only in selected patients with metastasis limited to the regional nodes. A sampling biopsy of the para-aortic nodes before starting radical surgery is recommended because they are involved more frequently than expected.