Annals of surgical oncology · 2026
Extended Lymphadenectomy is Associated with Better Survival Outcome in Resected T1b-T4 Gallbladder Cancer: A 505-Patient Cohort Study.
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Chen Tianhao, Jin Yanwen, Wang Junke, Zhang Jie, Jia Qianbin, Li Fuyu, Zhou Rongxing, Ma Wenjie
Аннотация
BACKGROUND: The optimal extent of lymphadenectomy for gallbladder cancer (GBC) remains controversial. This study evaluated the prognostic impact of regional lymphadenectomy (R-LD) versus extended lymphadenectomy (E-LD) in patients undergoing radical resection for GBC.
METHODS: This retrospective cohort study included 505 patients who underwent surgery for GBC at our institution from 2010 to 2022. R-LD included nodes No. 8, 12, and 13, E-LD additionally included nodes No. 9, 14, and 16. Survival and prognostic factors were assessed using Kaplan-Meier curves and Cox regression analyses. Propensity score matching (PSM) was applied to reduce confounding.
RESULTS: Compared with R-LD, E-LD resulted in significantly higher lymph node retrieval (median, 7 vs. 2; P < 0.001) and detection of positive lymph nodes (median, 1 vs. 0; P < 0.001). E-LD was associated with increased postoperative morbidity (34.2% vs. 24.2%; P = 0.020). In the overall cohort, median overall survival was numerically longer with E-LD (19 vs. 15 months) without statistical significance (P = 0.056) , and disease-free survival was comparable (10 vs. 9 months; P = 0.318). Multivariable analysis identified E-LD as independently associated with survival (HR, 0.75; 95% CI, 0.59-0.96; P = 0.024). After propensity score matching, the OS benefit became significant (19 vs. 13 months; P = 0.011).
CONCLUSIONS: Extended lymphadenectomy improves nodal assessment and staging accuracy in patients with GBC undergoing radical resection and may provide additional oncological benefits. Although associated with increased postoperative morbidity, E-LD can be considered for T1b or higher-stage GBC with careful surgical technique and perioperative management.
METHODS: This retrospective cohort study included 505 patients who underwent surgery for GBC at our institution from 2010 to 2022. R-LD included nodes No. 8, 12, and 13, E-LD additionally included nodes No. 9, 14, and 16. Survival and prognostic factors were assessed using Kaplan-Meier curves and Cox regression analyses. Propensity score matching (PSM) was applied to reduce confounding.
RESULTS: Compared with R-LD, E-LD resulted in significantly higher lymph node retrieval (median, 7 vs. 2; P < 0.001) and detection of positive lymph nodes (median, 1 vs. 0; P < 0.001). E-LD was associated with increased postoperative morbidity (34.2% vs. 24.2%; P = 0.020). In the overall cohort, median overall survival was numerically longer with E-LD (19 vs. 15 months) without statistical significance (P = 0.056) , and disease-free survival was comparable (10 vs. 9 months; P = 0.318). Multivariable analysis identified E-LD as independently associated with survival (HR, 0.75; 95% CI, 0.59-0.96; P = 0.024). After propensity score matching, the OS benefit became significant (19 vs. 13 months; P = 0.011).
CONCLUSIONS: Extended lymphadenectomy improves nodal assessment and staging accuracy in patients with GBC undergoing radical resection and may provide additional oncological benefits. Although associated with increased postoperative morbidity, E-LD can be considered for T1b or higher-stage GBC with careful surgical technique and perioperative management.