An anatomical study of the lymphatic drainage of the gallbladder.

Based upon the detailed dissections of the lymphatic system of four adult cadavers, the lymphatic drainage of the gallbladder was divided into three pathways. 1) The cholecysto-retropancreatic pathway, which can be regarded as the main pathway, had two routes, one running spirally and posteriorly from the anterior surface of the common bile duct to the right, and the other running almost straight down from the posterior surface of the common bile duct. At the retroportal segment, these routes converged at a large lymph node, which appeared critical as the main terminal lymph node of this pathway. We designated this node the principal retroportal node. 2) The cholecysto-celiac pathway was the route by which some of the lymphatics from the gallbladder ran to the left through the hepatoduodenal ligament to reach the celiac nodes. 3) The cholecysto-mesenteric pathway was the route by which some of the lymphatics ran to the left in front of the portal vein and connected with the nodes at the superior mesenteric root. These three pathways converged with the abdomino-aortic lymph nodes near the left renal vein; in particular, the nodes in the interaortico-caval space were considered important.