Staging gallbladder cancer with lymphadenectomy: the practical application of new AHPBA and AJCC guidelines

Natasha L. Leigh, Daniel Solomon, Daniela Feingold, Spiros P. Hiotis, Daniel M. Labow, Deepa R. Magge, Umut Sarpel, Benjamin J. Golas

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: Current guidelines recommend harvesting a total lymph node count (TLNC) ≥6 from portal lymphadenectomy in ≥pT1b gallbladder cancers (GBC) for accurate staging and prognostication. This study aimed to determine nodal yields from portal lymphadenectomy and identify measures to maximize TLNC. Methods: We retrospectively reviewed all ≥pT1b GBC which underwent resection with curative intent including portal lymphadenectomy at our specialized HPB center from 2007 to 2017. We compared outcomes of TLNC < 6 and TLNC ≥ 6 cohorts and determined factors predictive of TLNC. Results: Of 92 patients, 20% had a TLNC ≥ 6 (IQR 7–11) and 9% had no nodes found on pathology. Malignant lymphadenopathy was twice as common in TLNC ≥ 6 as TLNC < 6 (p = 0.003) most frequently from portal, cystic and pericholedochal stations. On logistic regression analysis, concomitant liver resection was an independent predictor of higher TLNC [4b/5 wedge resection (OR 0.166, CI 0.057–0.486, p = 0.001) extended hepatectomy (OR 0.065, CI 0.012–0.340, p = 0.001)]; biliary resection and en bloc adjacent organ resection were not. Conclusion: At our center, prior to current guidelines, a TLNC≥6 was not met in 80% undergoing portal lymphadenectomy for ≥ pT1b GBC. To increase nodal yield, future guidelines should consider including additional lymph node stations and incorporation of frozen section analysis.

Original languageEnglish
Pages (from-to)1563-1569
Number of pages7
Issue number11
StatePublished - Nov 2019


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