BACKGROUND. Lymph node spread is the most common pattern of progressio
n in gallbladder carcinoma (GBC) and is a prognostic factor. The purpo
se of this study was to determine the prevalence of lymph node metasta
ses in patients with resected advanced GBC, and to evaluate the curati
ve effects of radical surgery for patients with lymph node metastasis.
METHODS. One hundred and eleven consecutive patients who had undergon
e radical surgery for GBC were included in this study. The pattern of
lymph node metastases was examined histopathologically, using the TNM
staging of the American Joint Committee on Cancer. RESULTS. There was
no neurovascular invasion or lymph node involvement in 15 patients wit
h pT1 tumors. Sixty of 96 patients with pT2-4 tumors had lymph node me
tastases. The pericholedochal lymph node was the most common metastati
c lymph node, followed by the cystic lymph node. The frequency of meta
stases in retroportal, posterosuperior pancreaticoduodenal, and intera
orticocaval lymph nodes was >15% in all cases. pT3-4 tumors had signif
icantly more lymph node involvement (79%) and significantly higher N2:
N1 ratios (2.5) than pT2 tumors (46% and 0.6, respectively). There was
no difference in 5-year survival between NO and N1 groups in pT2-4 tu
mors (66% in NO and 53% in NI). Patients with N2 disease had a signifi
cantly worse prognosis, but 4 patients survived >5 years. CONCLUSIONS.
The cystic and pericholedochal lymph nodes are the initial site of sp
read from GBC. The frequency of lymph node involvement is strongly inf
luenced by the depth of invasion of the primary tumor. GBC limited to
such lymph node metastases can be cured by surgery in >50% of such cas
es. (C) 1997 American Cancer Society.