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. 2014 Mar;16(3):229-34.
doi: 10.1111/hpb.12127. Epub 2013 Jul 22.

Role of routine 16b1 lymph node biopsy in the management of gallbladder cancer: an analysis

Anil K Agarwal  1 , Raja Kalayarasan, Amit Javed, Puja Sakhuja
Affiliations

Role of routine 16b1 lymph node biopsy in the management of gallbladder cancer: an analysis

Anil K Agarwal et al. HPB (Oxford). 2014 Mar.

Abstract

Background: Involvement of the 16b1 (interaortocaval) lymph node (LN) in gallbladder cancer (GBC) is considered to represent metastatic disease. Although this is universally accepted, the role of routine frozen-section histopathological examination (HPE) of the 16b1 LN in the management of GBC has not been previously reported.

Methods: A prospective study (August 2009-November 2011) using routine biopsy of 16b1 LNs and frozen-section HPE prior to radical resection in patients deemed operable on preoperative evaluation and staging laparoscopy was carried out.

Results: Of the 451 GBC patients assessed, 251 (55.7%) were deemed operable on preoperative imaging. Of these, 68 (27.1%) were found to have disseminated disease on staging laparoscopy/laparotomy. Of the 183 patients in whom 16b1 LN biopsy was performed, 34 (18.6%) had evidence of metastases on frozen-section HPE and the planned surgical resection was abandoned (Group A). Of the remaining 149 patients (Group B), 142 (95.3%) underwent curative resection and seven (4.7%) were found to be unresectable as a result of locoregionally advanced disease. A comparison of findings in Group A with those in Group B showed no significant difference in the clinical stage of the tumour. The proportions of patients with jaundice, elevated carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were significantly higher in Group A than in Group B (P = 0.008, P = 0.012 and P = 0.023, respectively).

Conclusions: Routine 16b1 LN biopsy prevented non-therapeutic radical resection and its associated morbidity in 18.6% of patients deemed resectable on preoperative imaging and staging laparoscopy. The yield was higher in patients with jaundice and elevated preoperative tumour marker levels.

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Figures

Figure 1
Figure 1
Flow chart showing the process of evaluation in 451 gallbladder cancer (GBC) patients assessed for operability during the period from August 2009 to November 2011. FNAC, fine needle aspiration cytology
Figure 2
Figure 2
The collecting trunks from the lymphatic plexuses in the gallbladder wall terminate in the cystic and pericholedochal lymph nodes (LNs) and follow one of three pathways to converge at the 16b1 LN in the interaortocaval location
See this image and copyright information in PMC

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