Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
Ann Surg Oncol. 2017 Sep;24(9):2474-2481. doi: 10.1245/s10434-017-5939-7. Epub 2017 Jun 26.
This study was designed to evaluate the prognostic value of positive posterior superior pancreaticoduodenal lymph nodes to clarify the need for dissection of these nodes.
A total of 148 patients with gallbladder carcinoma who underwent radical resection including dissection of the posterior superior pancreaticoduodenal nodes were enrolled. The incidence of metastasis and the survival rates among patients with metastasis to each lymph node group were calculated.
Of the 148 patients, 70 (47%) had nodal disease. The incidences of metastasis in the cystic duct, pericholedochal, retroportal, and hepatic artery node groups, defined as regional nodes in the UICC TNM staging system, ranged from 8.3 to 24.3% with 5-year survival rates of 12.5-46.4% in patients with positive nodes. The incidence of metastasis to the posterior superior pancreaticoduodenal nodes was 12.8% with a 5-year survival rate of 31.6% in patients with positive nodes. Survival after resection was significantly better in patients with distant nodal disease affecting only the posterior superior pancreaticoduodenal nodes (5-year survival, 55.6%) than in patients with distant nodal disease beyond these nodes (5-year survival, 15.0%; p = 0.046), whereas survival after resection was comparable between the former group and patients with regional nodal disease alone (5-year survival, 40.7%; p = 0.426).
In gallbladder carcinoma, involvement of the posterior superior pancreaticoduodenal nodes is similar to that of regional nodes in terms of both the incidence of metastasis and the impact on survival. Inclusion of the posterior superior pancreaticoduodenal nodes among the regional nodes should be considered.
本研究旨在评估阳性胰十二指肠上后淋巴结对预后的影响，以明确是否需要对这些淋巴结进行解剖。
共纳入 148 例接受根治性切除术（包括胰十二指肠上后淋巴结清扫术）的胆囊癌患者。计算了各淋巴结组转移的发生率和转移患者的生存率。
在 148 例患者中，70 例（47%）有淋巴结疾病。UICC TNM 分期系统中定义的区域性淋巴结（包括胆囊管、胆总管旁、门静脉后和肝动脉淋巴结组）的转移发生率为 8.3%至 24.3%，阳性淋巴结患者的 5 年生存率为 12.5%至 46.4%。胰十二指肠上后淋巴结转移的发生率为 12.8%，阳性淋巴结患者的 5 年生存率为 31.6%。仅累及胰十二指肠上后淋巴结的远处淋巴结转移患者（5 年生存率为 55.6%）的切除后生存率明显优于远处淋巴结转移超出这些部位的患者（5 年生存率为 15.0%；p=0.046），而前一组与仅存在区域性淋巴结疾病的患者的切除后生存率相当（5 年生存率为 40.7%；p=0.426）。
在胆囊癌中，后上胰十二指肠淋巴结的转移率和对生存的影响与区域淋巴结相似。应考虑将后上胰十二指肠淋巴结包括在区域淋巴结中。
