Eduardo A Vega1,2, Eduardo Vinuela2,3, Suguru Yamashita1,4, Marcel Sanhueza2,3, Gabriel Cavada5, Cristian Diaz2,3, Thomas A Aloia1, Yun Shin Chun1, Ching-Wei D Tzeng1, Masayuki Okuno1, Claire Goumard1, Jean-Nicolas Vauthey1, Jeffrey E Lee1, Claudius Conrad6. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA. 2. Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile. 3. Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile. 4. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan. 5. Department of Epidemiology, Faculty of Medicine and Public Health School, University of Los Andes Santiago, Santiago, Chile. 6. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA. cconrad1@mdanderson.org.
Abstract
BACKGROUND: We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus indicates whether an oncologic extended resection (OER) is required. METHODS: The study included patients who underwent OER for incidental gallbladder cancer (IGBC) during 1999-2015. Associations between a positive cystic duct node and D2 nodal status and disease-specific survival (DSS) were analyzed. RESULTS: One-hundred-eight-seven patients were included. Seventy-three patients (39%) had the incidental cystic duct node retrieved. Cystic duct node positivity was associated with positive D1 (odds ratio 5.2, p = 0.012) but not with D2. Among all patients, a positive cystic duct node was associated with worse DSS (hazard ratio [HR] 2.09). Patients without residual cancer at OER and positive incidental cystic duct node had similar DSS to patients with negative nodes 70 vs 60% (p = 0.337). Positive D1 (HR 6.07) or positive D2 (HR 13.8) was predictive of worse DSS. CONCLUSIONS: Patients with no residual cancer at OER and regional disease limited to their incidental cystic duct node have similar DSS to pN0 patients. The status of the cystic duct node only predicts the status of hepatic pedicle nodes.
BACKGROUND: We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus indicates whether an oncologic extended resection (OER) is required. METHODS: The study included patients who underwent OER for incidental gallbladder cancer (IGBC) during 1999-2015. Associations between a positive cystic duct node and D2 nodal status and disease-specific survival (DSS) were analyzed. RESULTS: One-hundred-eight-seven patients were included. Seventy-three patients (39%) had the incidental cystic duct node retrieved. Cystic duct node positivity was associated with positive D1 (odds ratio 5.2, p = 0.012) but not with D2. Among all patients, a positive cystic duct node was associated with worse DSS (hazard ratio [HR] 2.09). Patients without residual cancer at OER and positive incidental cystic duct node had similar DSS to patients with negative nodes 70 vs 60% (p = 0.337). Positive D1 (HR 6.07) or positive D2 (HR 13.8) was predictive of worse DSS. CONCLUSIONS:Patients with no residual cancer at OER and regional disease limited to their incidental cystic duct node have similar DSS to pN0 patients. The status of the cystic duct node only predicts the status of hepatic pedicle nodes.
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