Spectrum of lymphnodal involvement following extended cholecystectomy and its correlation with pT stage in carcinoma gall bladder patients

Abstract

Introduction: The spectrum of lymph nodal involvement following extended cholecystectomy and its correlation with pT Stage in carcinoma gall bladder patients is an area with less reported inspite of its pivotal role in staging and prognosis. Method: A prospective observational study including 57 patients with Carcinoma gall bladder who had undergone extended cholecystectomy with systematic lymphadenectomy between January 2014 to December 2015 in PGIMER, Chandigarh. All the resectable patients underwent standard extended Cholecystectomy with n aim to achieve R0 resections and lymphnodal dissection of cystic, pericholedochal, peripancreactic, periportal, coeliac artery, Common Hepatic Artery, LHA, RHA, Hepato-duodenal lymph nodes were sent separately with main specimen for evaluation. Result: Out of 57 patients, 8 were excluded (5 were xanthogranulomatous cholecystitis, 2 were chronic cholecystitis, 1 was IgG4 related disease). A total of 555 lymph nodes were examined in 49 patients with range of 0 to 26 and median of 11.79.Lymph nodal involvement found in 19 patients(38.7% ) out of 49. Lymph nodal involvement in order of frequency was peripancreatic (n=9/49;18.4%),common hepatic artery(n=7/49;14.3%), periportal(n=7/49;14.3%), hepato-duodenal(n=5/49;10.2%), pericholedochal (n=4/49;8.2%), cystic (n=3/49;6.1%) ,coeliac (n=2/49;4.1%), LHA nodes(1/49;2%) and RHA lymph nodes (1/49;2%). Lymph nodal involvement in our study with respect to tumor staging was, pT1 stage (n=5/49;10.2%) - periportal lymph nodes involved(n=1/5;20%), pT2 stage (n=12/49;24.5%) - pericholedochal (n=3/12;25%), cystic (n=2/12;16.6%) ,peripancreatic (n=2/12;16.6%) ,Common Hepatic Artery nodes (n=1/12;8.3%),periportal(n=1/12;8.3)hepato-duodenal nodes(n=1/12;8.3), pT3 stage tumors(n=32/49;65.3%) - peri-pancreatic(n=7/32;21.9%),Common Hepatic Artery (n=6/32;18.7%), periportal (n=5/32;15.6%),hepato-duodenal(n=4/32;12.5%) ,celiac (n= 2/32 ;6.25%) ,pericholdecochal (n=1/32;3.1%), LHA nodes (n=1/32;3.1%),RHA nodes(n=1/32;3.1%),cystic lymph nodes (n=1/32;3.1%) with p>0.05. Conclusion: Peripancreatic lymph nodes were the most commonly involved irrespective of ‘pT’stage. Our study mandates the role of systemic lymphadenctomy for better tumor clearance and staging even in early carcinoma Gallbladder however its translation in to better survival is yet to be studied.