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Standardized lymph node dissection for gallbladder cancer under laparoscopy: en-bloc resection technique

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Abstract

Purpose

Positive lymph node (LN) is a key prognostic factor in radically resected gallbladder cancer (GBCA). However, only a few underwent an adequate lymphadenectomy, and the number and extent of lymph node dissection (LND) have not been standardized. This study aims to develop an en bloc and standardized surgical procedure of LND for GBCA under laparoscopy.

Methods

Data of patients with GBCA underwent laparoscopic radical resection using a standardized and en bloc technique for LND were collected. Perioperative and long-term outcomes were retrospectively analyzed.

Results

A total of 39 patients underwent laparoscopic radical resection using standardized and en bloc technique for LND except one case (open conversion rate: 2.6%). Patients with stage T1b had significantly lower LNs involved rate than patients with stage T3 (P = 0.04), whereas median LN count in stage T1b was significantly higher than that in stage T2 (P = 0.04), which was significantly higher than that in stage T3 (P = 0.02). Lymphadenectomy with ≥ 6 LNs accounted for 87.5% in stage T1b, up to 93.3% in T2 and 81.3% in T3, respectively. All the patients in stage T1b were alive without recurrence at this writing. The 2-year recurrence-free survival rate was 80% for T2 and 25% for T3, and the 3-year overall survival rate was 73.3% for T2 and 37.5% for T3.

Conclusion

The standardized and en bloc LND permits complete and radical removal of lymph stations for patients with GBCA. This technique is safe and feasible with low complication rates and good prognosis. Further studies are required to explore its value and long-term outcomes compared to conventional approaches.

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Data Availability

Our medical ethics committee imposed ethical and legal restrictions on sharing a deidentified data set, because the data contain potentially identifying and sensitive patient information. Upon request, the request for data should be reached by our medical ethics committee (Email: zryllwyh@163.com; Telephone: +86-571-85893677) or sent to the corresponding author (Email: zcwzry@163.com).

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Authors and Affiliations

  1. General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China

    Jian Cheng, Jie Liu, Chang-Wei Dou, Zhong-Chun **e, Bing-Fu Fan, Li-Ming **, Lei Liang & Cheng-Wu Zhang

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  1. Jian Cheng
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  2. Jie Liu
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  3. Chang-Wei Dou
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  4. Zhong-Chun **e
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  5. Bing-Fu Fan
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  6. Li-Ming **
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  7. Lei Liang
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  8. Cheng-Wu Zhang
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Contributions

Study conception and design: Jian Cheng, Cheng-Wu Zhang, Jie Liu, Chang-Wei Dou; acquisition of data: Zhong-Chun **e, Bing-Fu Fan; analysis and interpretation of data: Jian Cheng, Lei Liang; drafting of manuscript: Jian Cheng, Jie Liu, Chang-Wei Dou; critical revision of manuscript: Cheng-Wu Zhang, Li-Ming **. All authors read and approved the final manuscript.

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Correspondence to Cheng-Wu Zhang.

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Cheng, J., Liu, J., Dou, CW. et al. Standardized lymph node dissection for gallbladder cancer under laparoscopy: en-bloc resection technique. Langenbecks Arch Surg 408, 183 (2023). https://doi.org/10.1007/s00423-023-02924-2

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