Interaortocaval Lymph Node Metastasis in Gall Bladder Cancer: Is It Regional Node or Metastatic Disease?

BACKGROUND AND OBJECTIVES: Interaortocaval or para-aortic lymph node (IACLN) metastasis in gall bladder cancer (GBC) is usually a contraindication to curative resection with a prognosis similar to liver or peritoneal metastases. However, few authors have reported survival similar to regional lymph node (RLN) positive disease after curative resection in these patients. This study aims to analyse the role of curative surgery in such cases. METHODS: Data of all patients operated for GBC from 2012 to 2019 was retrieved. Survival of the IACLN- and RLN-positive patients was compared and factors associated with recurrence and survival were analysed. RESULTS: Patients were divided in RLN-positive (n = 47) and IACLN-positive (n = 17) group. At a median follow-up of 19.7 months, median disease-free survival (18 vs 13 months) and median overall survival (27 vs 20 months) were inferior (p = 0.06) in IACLN group. But it was higher than the patients who received only palliative therapy (median OS, 14 months). Lack of adjuvant therapy was a significant factor for disease recurrence. CONCLUSION: Selected cases of GBC with IACLN metastases can achieve meaningful survival after curative resection and adjuvant therapy. Survival was inferior to RLN-positive cases but it was higher than the patients who received only palliative chemotherapy. This concept needs further evaluation in a prospective study with larger number of patients.

Robot assisted minimally invasive esophagectomy: safety, perioperative morbidity and short-term oncological outcome-a single institution experience.

Robot assisted minimally invasive esophagectomy (RAMIE) has evolved over the past decade to become procedure of choice at many centers all over the world. The objective of this study is to present our experience of robot assisted minimally invasive esophagectomy with respect to perioperative morbidity and short-term oncological outcomes and a comparison of the same to a cohort of our patients who underwent open Mckeown's esophagectomy. This is a retrospective analysis of prospectively collected data of patients from October 2011 to October 2019. A total of 56 patients in open group and 58 patients in robotic group were enrolled. Upper and middle third was the most common site for open esophagectomy while middle and lower third was more common site for robotic esophagectomy (p < 0.0001). Median operative time was 340 min for open and 360 min for robotic esophagectomy (p = 0.004). A median of 16 lymph nodes were retrieved in either group. R0 resection was achieved in 86% in open and 97% in robotic group (p = 0.04). Median intensive care unit (ICU) stay (2 days versus 5 days) and median hospital stay (10.5 days versus 14.5 days) were both favoring for robotic group (p < 0.0001). Cardiac arrhythmias and pulmonary complications requiring ICU readmission occurred less frequently in patients undergoing robotic esophagectomy (p = 0.02). Two-year overall survival (p = 0.09) and 2-year disease-free survival (p = 0.32) was similar between the groups. RAMIE significantly reduced ICU as well as hospital stay and had oncological outcome similar to open Mckeown's esophagectomy.