AIM:To explore risk factors of lymphatic metastasis(LM)in gallbladder cancer,and their potential to complement unsatisfactory radiological detection.METHODS:Radiological detection of LM by computed tomography(CT)was reported to fail in more than60%of patients with pathological LM.In order to find risk factors highly suggestive of LM other than radiological manifestations,the documents of 63 patients were analyzed statistically.Except for 4 patients having T1a disease,in whom cholecystectomy is enough for radical resection,59 patients underwent lymphadenectomy with at least 3 lymph nodes dissected.Fifty point eight percent(32/63)of patients were found to have LM during pathological examination.The median number of dissected lymph nodes was 6(range 3-20).RESULTS:Only 31.3%(10/32)of patients with LM were detected by CT.Through multivariate analysis,two risk factors of LM were discovered as age<60years(OR=6.24;P<0.01)and carbohydrate antigen(CA)19-9 elevation(OR=5.70;P<0.05).By analysis of patients with pathological LM but failed to be detected by CT,81.8%(18/22)of patients had at least one risk factor,including 31.3%(10/32)who had the risk factor of age<60 years,and 37.5%(12/32)who had the risk factor of CA 19-9 elevation.Besides,among patients with LM(n=32),those whose age were younger than 60 years(OR=3.41;P<0.05)were more likely to have 3 or more positive lymph nodes.CONCLUSION:Age<60 years and CA 19-9 elevation could complement radiological detection of LM.Patients aged<60 years are at higher risk of multiple positive nodes. AIM: To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection. METHODS: Radiological detection of LM by computed tomography (CT) was reported to fail in more than 60% of patients with pathological LM In order to find risk factors highly suggestive of LM other than radiological manifestations, the documents of 63 patients were analyzed statistically. Except for 4 patients with T1a disease, in whom cholecystectomy is enough for radical resection, 59 patients underwent lymphadenectomy with at least 3 lymph nodes dissected .Fifty point eight percent (32/63) of patients were found to have LM during pathological examination.The median number of dissected lymph nodes was 6 (range 3-20) .RESULTS: Only 31.3% (10/32) of patients with LM were detected by CT.Through multivariate analysis, two risk factors of LM were discovered as age <60 years (OR = 6.24; P <0.01) and carbohydrate antigen (CA) 0.05) .By analysis of patients with pathological LM but failed to be detected by CT, 81.8% (18/22) of patients had at least one risk factor, including 31.3% (10/32) who had the risk factor of age <60 years, and 37.5% (12/32) who had the risk factor of CA 19-9 elevation.Besides, among patients with LM (n = 32), those whose older were younger than 60 years (OR = 3.41; P <0.05) were more likely to have 3 or more positive lymph nodes. CONCLUSION: Age <60 years and CA 19-9 elevation could complement radiological detection of LM.Patients aged <60 years are at higher risk of multiple positive nodes.