Comparison of lymph node evaluation and yield among patients undergoing open and minimally invasive surgery for gallbladder adenocarcinoma.
Gallbladder cancer
Lymph node
Minimally invasive surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
09
02
2020
accepted:
13
05
2020
pubmed:
21
5
2020
medline:
28
7
2021
entrez:
21
5
2020
Statut:
ppublish
Résumé
Assessment of regional lymph nodes (LN) is essential for determining prognosis among patients with gallbladder cancer (GBC). The impact of surgical technique on LN yield has not been well explored. We investigated the impact of minimally invasive surgery (MIS; robotic or laparoscopic) on the evaluation and retrieval of regional LN for patients with GBC. We queried the National Cancer Database (NCDB) to identify patients with GBC who underwent curative-intent surgery between 2010 and 2015. Patients with metastatic disease or those with missing data on surgical resection or LN evaluation were excluded. We identified 2014 patients who underwent an open (n = 1141, 56.6%) or MIS approach (n = 873, 43.4%) for GBC and met the inclusion criteria. Patients who underwent MIS were older (open: 68 years, IQR: 60, 75 vs. MIS: 70 years, IQR (61, 77); P = 0.02), and were more commonly treated at a comprehensive community cancer program (P < 0.001). Approximately 3 out of 4 patients (n = 1468, 72.9%) underwent an evaluation of regional LN, with nearly half of these patients (n = 607, 41.7%) having LN metastasis. Among patients who underwent a regional lymphadenectomy, average lymph node yield was 3 (IQR: 1, 6) and was similar between the two groups (P = 0.04). After controlling for all factors, operative approach was not associated with likelihood of receiving a lymphadenectomy during curative-intent resection (OR 0.81, 95% CI 0.63-1.04; P = 0.11). In conclusion, patients undergoing curative-intent resection for GBC had similar rates of lymph node evaluation and yield regardless of operative approach. Over one-quarter of patients did not undergo a lymphadenectomy at the time of surgery. Further studies are needed to identify barriers to lymph node evaluation and yield among patients undergoing surgery for gallbladder cancer. Presented at the 2019 2nd World Congress of the International Laparoscopic Liver Society, Tokyo, Japan.
Identifiants
pubmed: 32430521
doi: 10.1007/s00464-020-07635-z
pii: 10.1007/s00464-020-07635-z
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2223-2228Références
Lazcano-Ponce EC, Miquel JF, Munoz N et al (2001) Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. https://doi.org/10.3322/canjclin.51.6.349
doi: 10.3322/canjclin.51.6.349
pubmed: 11760569
Hundal R, Shaffer EA (2014) Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. https://doi.org/10.2147/CLEP.S37357
doi: 10.2147/CLEP.S37357
pubmed: 24634588
pmcid: 3952897
Buettner S, Margonis GA, Kim Y et al (2016) Changing odds of survival over time among patients undergoing surgical resection of gallbladder carcinoma. Ann Surg Oncol. https://doi.org/10.1245/s10434-016-5470-2
doi: 10.1245/s10434-016-5470-2
pubmed: 27812827
pmcid: 6054592
Tsilimigras DI, Hyer JM, Paredes AZ et al (2019) The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: correlating the number of nodes removed with survival in 6531 patients. J Surg Oncol. https://doi.org/10.1002/jso.25450
doi: 10.1002/jso.25450
pubmed: 31742706
pmcid: 7263435
Amini N, Spolverato G, Kim Y et al (2015) Lymph node status after resection for gallbladder adenocarcinoma: prognostic implications of different nodal staging/scoring systems. J Surg Oncol. https://doi.org/10.1002/jso.23813
doi: 10.1002/jso.23813
pubmed: 25348367
Amini N, Kim Y, Wilson A et al (2016) Prognostic implications of lymph node status for patients with gallbladder cancer: a multi-institutional study. Ann Surg Oncol. https://doi.org/10.1245/s10434-016-5243-y
doi: 10.1245/s10434-016-5243-y
pubmed: 27696170
pmcid: 5456271
Tran TB, Nissen NN (2015) Surgery for gallbladder cancer in the US: a need for greater lymph node clearance. J Gastrointest Oncol. https://doi.org/10.3978/j.issn.2078-6891.2015.062
doi: 10.3978/j.issn.2078-6891.2015.062
pubmed: 26487937
pmcid: 4570923
Dixon E, Vollmer CM, Sahajpal A et al (2005) An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center. Ann Surg. https://doi.org/10.1097/01.sla.0000154118.07704.ef
doi: 10.1097/01.sla.0000154118.07704.ef
pubmed: 15973104
pmcid: 1357707
Ejaz A, Sachs T, He J et al (2014) A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the nationwide inpatient sample. Surgery. https://doi.org/10.1016/j.surg.2014.03.046
doi: 10.1016/j.surg.2014.03.046
pubmed: 25017135
pmcid: 4316739
Vega EA, Sanhueza M, Viñuela E (2019) Minimally invasive surgery for gallbladder cancer. Surg Oncol Clin N Am. https://doi.org/10.1016/j.soc.2018.11.001
doi: 10.1016/j.soc.2018.11.001
pubmed: 30851826
Boffa DJ, Rosen JE, Mallin K et al (2017) Using the national cancer database for outcomes research a review. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2016.6905
doi: 10.1001/jamaoncol.2016.6905
pubmed: 28241198
pmcid: 5824207
Feng JW, Yang XH, Liu CW et al (2019) Comparison of laparoscopic and open approach in treating gallbladder cancer. J Surg Res. https://doi.org/10.1016/j.jss.2018.09.025
doi: 10.1016/j.jss.2018.09.025
pubmed: 31676144
Mayo SC, Shore AD, Nathan H et al (2010) National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis. J Gastrointest Surg. https://doi.org/10.1007/s11605-010-1335-3
doi: 10.1007/s11605-010-1335-3
pubmed: 20824371
Nag HH, Raj P, Sisodia K (2018) The technique of laparoscopic hepatic bisegmentectomy with regional lymphadenectomy for gallbladder cancer. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_181_16
doi: 10.4103/jmas.JMAS_181_16
pubmed: 28928327
pmcid: 5869971
Tam V, Borrebach J, Dunn SA, Bellon J, Zeh HJ, Hogg ME (2019) Proficiency-based training and credentialing can improve patients outcomes and decrease cost to a hospital system. Am J Surg. https://doi.org/10.1016/j.amjsurg.2018.07.053
doi: 10.1016/j.amjsurg.2018.07.053
pubmed: 30098709
Fretland AA, Dagenborg VJ, Bjørnelv GMW et al (2018) Laparoscopic versus open resection for colorectal liver metastases. Ann Surg. https://doi.org/10.1097/SLA.0000000000002353
doi: 10.1097/SLA.0000000000002353
pubmed: 29303812
Hilal MA, Aldrighetti L, Dagher I et al (2018) The Southampton Consensus Guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. https://doi.org/10.1097/SLA.0000000000002524
doi: 10.1097/SLA.0000000000002524
pubmed: 29401109