OBJECTIVE: To assess the status of the regional and paraaortic lymph nodes in hilar cholangiocarcinoma and to clarify the efficacy of systematic extended lymphadenectomy. SUMMARY BACKGROUND DATA: There have been no studies in which regional and paraaortic lymphadenectomies for hilar cholangiocarcinoma have been routinely performed. Therefore, the metastasis rates to the regional and paraaortic nodes, the mode of lymphatic spread, and the effect of extended lymph node dissection on survival remain unknown. METHODS: This study involved 110 patients who underwent surgical resection for hilar cholangiocarcinoma with lymph node dissection including both the regional and paraaortic nodes. A total of 2,652 nodes retrieved from the surgical specimens were examined microscopically. RESULTS: Of the 110 patients, 52 (47.3%) had no involved nodes, 39 (35.5%) had regional lymph node metastases, and 19 (17.3%) had regional and paraaortic node metastases. The incidence of positive nodes was significantly higher in the patients with pT3 disease than in those with pT2 disease. The pericholedochal nodes were most commonly involved (42.7%), followed by the periportal nodes (30.9%), the common hepatic nodes (27.3%), and the posterior pancreaticoduodenal nodes (14.5%). The celiac and superior mesenteric nodes were rarely involved. The 3-year and 5-year survival rates were 55.4% and 30.5% for the 52 patients without involved nodes, 31.8% and 14.7% for the 39 patients with regional node metastases, and 12.3% and 12.3% for the 19 patients with paraaortic node metastases, respectively. Of the 19 patients with positive paraaortic nodes, 7 had no macroscopic evidence of paraaortic disease on intraoperative inspection. The survival in this group was significantly better than in the remaining 12 patients. CONCLUSION: The paraaortic nodes and the regional nodes are frequently involved in advanced hilar cholangiocarcinoma. Whether extended lymph node dissection provides a survival benefit requires further study. However, the fact that long-term survival is possible despite pN2 or pM1 disease encourages the authors to perform an aggressive surgical procedure with extended lymph node dissection in selected patients with hilar cholangiocarcinoma.
OBJECTIVE: To assess the status of the regional and paraaortic lymph nodes in hilar cholangiocarcinoma and to clarify the efficacy of systematic extended lymphadenectomy. SUMMARY BACKGROUND DATA: There have been no studies in which regional and paraaortic lymphadenectomies for hilar cholangiocarcinoma have been routinely performed. Therefore, the metastasis rates to the regional and paraaortic nodes, the mode of lymphatic spread, and the effect of extended lymph node dissection on survival remain unknown. METHODS: This study involved 110 patients who underwent surgical resection for hilar cholangiocarcinoma with lymph node dissection including both the regional and paraaortic nodes. A total of 2,652 nodes retrieved from the surgical specimens were examined microscopically. RESULTS: Of the 110 patients, 52 (47.3%) had no involved nodes, 39 (35.5%) had regional lymph node metastases, and 19 (17.3%) had regional and paraaortic node metastases. The incidence of positive nodes was significantly higher in the patients with pT3 disease than in those with pT2 disease. The pericholedochal nodes were most commonly involved (42.7%), followed by the periportal nodes (30.9%), the common hepatic nodes (27.3%), and the posterior pancreaticoduodenal nodes (14.5%). The celiac and superior mesenteric nodes were rarely involved. The 3-year and 5-year survival rates were 55.4% and 30.5% for the 52 patients without involved nodes, 31.8% and 14.7% for the 39 patients with regional node metastases, and 12.3% and 12.3% for the 19 patients with paraaortic node metastases, respectively. Of the 19 patients with positive paraaortic nodes, 7 had no macroscopic evidence of paraaortic disease on intraoperative inspection. The survival in this group was significantly better than in the remaining 12 patients. CONCLUSION: The paraaortic nodes and the regional nodes are frequently involved in advanced hilar cholangiocarcinoma. Whether extended lymph node dissection provides a survival benefit requires further study. However, the fact that long-term survival is possible despite pN2 or pM1 disease encourages the authors to perform an aggressive surgical procedure with extended lymph node dissection in selected patients with hilar cholangiocarcinoma.
Authors: K Tsukada; I Kurosaki; K Uchida; Y Shirai; Y Oohashi; N Yokoyama; H Watanabe; K Hatakeyama Journal: Cancer Date: 1997-08-15 Impact factor: 6.860
Authors: A Nakeeb; H A Pitt; T A Sohn; J Coleman; R A Abrams; S Piantadosi; R H Hruban; K D Lillemoe; C J Yeo; J L Cameron Journal: Ann Surg Date: 1996-10 Impact factor: 12.969
Authors: S A Khan; B R Davidson; R Goldin; S P Pereira; W M C Rosenberg; S D Taylor-Robinson; A V Thillainayagam; H C Thomas; M R Thursz; H Wasan Journal: Gut Date: 2002-11 Impact factor: 23.059
Authors: J R A Skipworth; S W M Olde Damink; C Imber; J Bridgewater; S P Pereira; M Malagó Journal: Aliment Pharmacol Ther Date: 2011-09-20 Impact factor: 8.171
Authors: Anthony T Ruys; Fiebo J W Ten Kate; Olivier R Busch; Marc R Engelbrecht; Dirk J Gouma; Thomas M van Gulik Journal: HPB (Oxford) Date: 2011-09-26 Impact factor: 3.647
Authors: Helmut Witzigmann; Frieder Berr; Ulrike Ringel; Karel Caca; Dirk Uhlmann; Konrad Schoppmeyer; Andrea Tannapfel; Christian Wittekind; Joachim Mossner; Johann Hauss; Marcus Wiedmann Journal: Ann Surg Date: 2006-08 Impact factor: 12.969
Authors: Kevin Tri Nguyen; Jennifer Steel; Tsafrir Vanounou; Allan Tsung; J Wallis Marsh; David A Geller; T Clark Gamblin Journal: Ann Surg Oncol Date: 2009-09-23 Impact factor: 5.344