The Study Of Regional Lymphadenectomy Of The Lymph Nodes In The Regions Of Head Of Pancreas For Patients With T3 And T4 Gallbladder Cancer

ObjectiveTo investigate the efficacy of regional lymphadenectomy for patients with T3 and T4 gallbladder cancer.MethodsFrom January 2009 to December 2013,182 patients with T3 and T4 GBC received regional lymphadenectomy following radical surgery at Eastern Hepatobiliary Surgery Hospital, and their clinical data were retrospectively analyzed. Patients were divided into five groups according to the pT stage and the range of lymphadenectomy. T3 Standard group(78 patients):lymph nodes in the regions of hepatoduodenal ligament and common hepatic artery were dissected; T3 extended group(40 patients):lymph nodes in the regions of hepatoduodenal ligament, head of pancreas and common hepatic artery were dissected). T4 Standard group(39 patients): lymph nodes in the regions of hepatoduodenal ligament and common hepatic artery were dissected; T4 extended group(19 patients):lymph nodes in the regions of hepatoduodenal ligament, head of pancreas and common hepatic artery were dissected); HPD group(6 patients):lymph nodes in the regions of hepatoduodenal ligament, head of pancreas, common hepatic artery and celiac axis were dissected).The condition of patients in the five groups were compared after the treatment. The morbidity and survival rate were analyzed by using Fisher exact test, x 2 and Kaplan-Meier method, respectively, and the survival rate between the antithetical groups was compared by using Log-rank test.ResultsAccording to the UICC Staging (7th edition),118 cases were pT3.64 cases were pT4. The overall rate of nodal involvement was 80.2%(146/182). lymphatic metastasis in pT3 and pT4 were 75.4%(89/118),89.1%(57/64).The median survival time were 11 months in the T3 standard group, and 30 months in the T3 extended group, with significant differences between the two groups(P<0.05). The median survival time were 8 months in the T4 standard group, and 18 months in the T4 extended group, with significant differences between the two groups(P<0.05). The median survival time were 18 months in the T4 extended group, and 15 months in the HPD group, with no significant differences between the two groups(P>0.05). No perioperative death was found in the five groups. The morbidities was 14.1%(11/78) in the T3 standard group,15.0%(6/40) in the T3 extended group,15.3%(6/39) in the T4 standard group,15.8%(3/19) in the T4 extended group,50%(3/6) in the HPD group, with no significant difference between the antithetical groups(P>0.05).ConclusionsExtended regional lymphadenectomy should be performed on patients with T3 and T4 gallbladder cancer if the primary lesions can be dissected radically.