Lymph node evaluation in gallbladder cancer: which role in the prognostic and therapeutic aspects. Update of the literature

OBJECTIVE: The widespread use of laparoscopy has changed the outcome ofgallbladder cancer as a consequence of increasing referral and incidentaldiscovering of earlier stages cancer. Nevertheless, GBC is still associated with a poor prognosis and lymphnodal involvement is a main prognostic factor,important both for staging and for evaluating surgery quality. No consensusexists about the extension of lymphadenectomy to be performed nor aboutcontraindications to extensive resection. A review of literature was so designed to identify the actual role, extension and limits of lymphadenectomy.MATERIALS AND METHODS: A search on Pubmed and Scopus has been performed using thefollowing keywords: gallbladder cancer, gallbladder neoplasm, surgery,laparoscopy, lymphadenectomy to evaluate the prognostic and the therapeutic role of the lymphadenectomy in gallbladder cancer. The retrieved articles wereanalyzed aimed to evaluate the impact of lymphectomy and of its extension onoverall and disease free survival.RESULTS: Although no consensus still exists over the extension of ideallymphadenectomy, some points are already clearly established: a part from T1aneoplasms, that do not require further surgery, and T1b for which a regionallymphectomy (N1) is safe and mandatory, more advanced stages require a moreaggressive surgery but the fate of paraortic nodal station is still underevaluation. In fact some Authors still believe that the involvement of thesenodes determine a so poor prognosis to make uselessly risky their surgicalaggression. Other Authors conversely, show that there is not any difference insurvival, among node positive patients, between paraortic node positive and noparaortic node positive patients.CONCLUSIONS: The prognosis of gallbladder cancer remains poor because in mostpatients the diagnosis is made at an advanced stage. Complete surgical resection provides the only curative treatment option in this disease. In order to improve long-term outcome, several surgeons have advocated aggressive surgical resection,including major hepatectomy, pancreatoduodenectomy and extended lymphadenectomy. Even a para-aortic nodal disease shouldn't discourage from pursuing thisobjective.