Open versus laparoscopic portal lymphadenectomy in gallbladder cancer: is there a difference in lymph node yield?
- Ong CT Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Leung K Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Nussbaum DP Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Sun Z Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Gloor B Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- Blazer DG Department of Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: trey.blazer@duke.edu.
- Worni M Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- 2018-02-24
Published in:
- HPB : the official journal of the International Hepato Pancreato Biliary Association. - 2018
Academic Medical Centers
Aged
Conversion to Open Surgery
Databases, Factual
Female
Gallbladder Neoplasms
Hospitals, High-Volume
Humans
Laparoscopy
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Retrospective Studies
Risk Factors
Treatment Outcome
United States
English
BACKGROUND
Gallbladder cancer (GBC) is the most common biliary tract malignancy. Because it commonly metastasizes via lymphatics, portal lymphadenectomy should be included in oncologic resections. This study aimed to compare the oncologic equivalence of the laparoscopic versus open technique by evaluating lymph node (LN) yield.
METHODS
The 2010-2012 National Cancer Data Base identified patients who underwent laparoscopic or open resection of GBC with dedicated lymphadenectomy. LN yield was compared by resection method. Variables associated with LN yield ≥3 were identified.
RESULTS
Of 1524 patients identified, 52% were intended to undergo laparoscopic surgery, with 20% of these patients converted to open. Collection of ≥3 LNs following open resection (47%) was higher than for laparoscopic resection (34%), p < 0.001. Operations performed at high-volume (aOR:1.74, p < 0.001) and/or academic centers (aOR:1.70, p = 0.024) had superior LN yield. LN yield was not associated with overall survival (aHR:0.93, p = 0.493).
CONCLUSIONS
In this analysis of national data, LN yield following laparoscopic resection for GBC was significantly lower than following open resection. Open resection is more frequently performed at academic centers, possibly to assure adequate oncologic resection. Enforcing consensus guidelines for lymphadenectomy in gallbladder cancer will optimize outcomes as minimally invasive approaches evolve.
Gallbladder cancer (GBC) is the most common biliary tract malignancy. Because it commonly metastasizes via lymphatics, portal lymphadenectomy should be included in oncologic resections. This study aimed to compare the oncologic equivalence of the laparoscopic versus open technique by evaluating lymph node (LN) yield.
METHODS
The 2010-2012 National Cancer Data Base identified patients who underwent laparoscopic or open resection of GBC with dedicated lymphadenectomy. LN yield was compared by resection method. Variables associated with LN yield ≥3 were identified.
RESULTS
Of 1524 patients identified, 52% were intended to undergo laparoscopic surgery, with 20% of these patients converted to open. Collection of ≥3 LNs following open resection (47%) was higher than for laparoscopic resection (34%), p < 0.001. Operations performed at high-volume (aOR:1.74, p < 0.001) and/or academic centers (aOR:1.70, p = 0.024) had superior LN yield. LN yield was not associated with overall survival (aHR:0.93, p = 0.493).
CONCLUSIONS
In this analysis of national data, LN yield following laparoscopic resection for GBC was significantly lower than following open resection. Open resection is more frequently performed at academic centers, possibly to assure adequate oncologic resection. Enforcing consensus guidelines for lymphadenectomy in gallbladder cancer will optimize outcomes as minimally invasive approaches evolve.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.hpb.2017.10.015
- PMID 29472106
- Persistent URL
- https://sonar.ch/global/documents/278727
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