Significance of Inter aorto-caval lymph nodes in gall bladder cancer management.

Abstract

e16607 Background: Gallbladder cancer (GBC) is one of the three leading cancer among women of North and North-east India. The age standardized rate (ASR) for GBC in women of North and north-east India are 11.8/100,000 population and 17.1/100,000 population respectively It is one of the most fatal cancer, characterized by early spread, both local as well as distant. Radical resection is associated with the highest control rates. Presence of inter-aorto-caval lymph nodes (IAC) during preoperative workup is designated as metastatic disease in GBC and radical surgery is deferred. This study attempts to confirm the validity of such an approach. Methods: Between January 2017 and December 2018, 178 patients of GBC were registered at our hospital. Of these, 108 patients with radiologically resectable disease were evaluated preoperatively with endoscopic ultrasound (EUS) to look for IAC lymph nodes lying below the level of the renal vein. Patients with IAC involvement were taken up for chemotherapy while the others underwent upfront surgery. Results: Mean age at presentation was 51.1 (±10.9) years with a female predominance (N = 77, 71.2%). Presenting symptoms were either pain (N = 91, 84.2%) or jaundice (N = 42, 38.8%) in majority cases. Patients with jaundice presented earlier with mean of 53.27 days (Range2-240 days) while those with pain presented at a mean of 71.5 days (1-360 days) prior to diagnosis. Pathologically positive IAC cases (n = 12) of resectable GBC received systemic therapy upfront rather than immediate radical surgery. Rest of the patients underwent surgical resection followed by adjuvant treatment as indicated. Mean follow up was 179 days with a mortality of 62%(n = 67). No significant difference was seen in the stage distribution in IAC positive versus negative group. Median survival with Kaplan Meier method of IAC positive patients was 239 days versus 190 days in IAC negative patients. Conclusions: IAC lymph node may not necessarily portend poor prognosis. It needs to be validated in large sample size.