Nalini Kanta Ghosh1, Ashish Singh1, Rahul, Supriya Sharma1, Ashok Kumar1, Rajneesh Kumar Singh1, Anu Behari1, Ashok Kumar1, Vinay Kumar Kapoor1, Rajan Saxena1

1Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India 226014

Background/Aims: Gallbladder cancer (GBC) is the most common biliary tract malignancy and the fifth most common site of malignancy in the gastrointestinal tract. Lymph node metastasis is associated with poor prognosis. There is conflicting evidence in literature regarding aggressive surgery in stage IV gall bladder cancers, especially for curative surgery in presence of retroperitoneal lymph nodal metastasis (RLNM). We have been abandoning radical surgery in patients with RLNM. This is a retrospective analysis of patients, in whom a curative resection was abandoned due to the presence of retroperitoneal lymph node metastasis (RLNM - Interaorto-caval and para-aortic) or distant metastasis (DM - peritoneal, liver, omental nodule and/or malignant ascites), to see the effect of RLNM on survival of the GBC patients.

Methods: A retrospective analysis of prospectively collected data base of the patients with GBC found to have RLNM or DM on frozen section biopsy at surgery, between January 2013 and December 2018. Data was analysed using the SPSS software (version 22.0). Survival in these two groups (RLNM and DM) was compared with log rank test. P-value of <0.05 was considered significant.

Results: 235 resectable GBC patients underwent surgical exploration. The planned curative resection was abandoned in 91 (39%) patients because of RLNM (n=20, 9%) or DM (n=71, 30%) on frozen section biopsy. Demographic profile and blood parameters were similar in the two groups. The median survival for RLNM and DM groups were 5 (range 2-26; IQR 3-11) and 6 (range 2-24; IQR 4-10) months, respectively. No significant difference was documented on log rank test. (p =0.64). There was no 3-year in either group.

Conclusion: GBC patients with RLNM/ DM have similarly poor survival. At surgery retroperitoneal (interaorto-caval and para-aortic) LNs should be sampled as a routine for frozen section histological examination before initiating curative resection to avert a futile exercise.

Keywords: Gallbladder cancer, Retroperitoneal lymph-node, Metastasis, Survival