Dong Hun Kim1, Dong Wook Choi2, Seong Ho Choi3, Jin Seok Heo3, Alfred Wei-Chieh Kow4. 1. Department of Surgery, Dankook University Hospital, Cheonan, Republic of Korea. 2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: dwchoi@skku.edu. 3. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Hepatopancreatobiliary and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore.
Abstract
BACKGROUND: Although use of lymphadenectomy for treatment of extrahepatic cholangiocarcinoma is established, routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) remains controversial. We examined the factors predicting survival in patients after ICC resection and compared outcomes of patients with and without systematic hepatic pedicle lymph node dissection (LND). METHODS: Data were retrospectively collected for 215 patients with ICC who underwent liver resection during the years 1995-2012. Patients were divided into those (n = 102; 47.4%) who received LND (LN [D]) and those (n = 113; 52.6%) who did not (LN [D0]). RESULTS: Demographic data were similar between the 2 groups except for presence of preoperative symptom (P = .019) and liver cirrhosis (P < .001), carbohydrate antigen 19-9 (P = .003), tumor location according to the hepatic lobe (P < .001), type of hepatectomy (P < .001), adjuvant treatment (P < .001), and postoperative complications (P = .028). Tumor recurrence at a distant site was observed in 102 patients (68.5%). LN metastasis was independently associated with risk of distant recurrence (P = .002). The LN (D) and LN (D0) groups did not differ in overall survival (P = .101) or disease-free survival (P = .111). Poorly differentiated histologic grade (P = .016) and LN metastasis (P < .001) was identified as an independent predictor of overall survival. CONCLUSION: Routine LND for ICC did not show survival benefits; however, LN sampling might be useful for nodal staging, an essential factor in predicting outcome and deciding whether to apply adjuvant treatment.
BACKGROUND: Although use of lymphadenectomy for treatment of extrahepatic cholangiocarcinoma is established, routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) remains controversial. We examined the factors predicting survival in patients after ICC resection and compared outcomes of patients with and without systematic hepatic pedicle lymph node dissection (LND). METHODS: Data were retrospectively collected for 215 patients with ICC who underwent liver resection during the years 1995-2012. Patients were divided into those (n = 102; 47.4%) who received LND (LN [D]) and those (n = 113; 52.6%) who did not (LN [D0]). RESULTS: Demographic data were similar between the 2 groups except for presence of preoperative symptom (P = .019) and liver cirrhosis (P < .001), carbohydrate antigen 19-9 (P = .003), tumor location according to the hepatic lobe (P < .001), type of hepatectomy (P < .001), adjuvant treatment (P < .001), and postoperative complications (P = .028). Tumor recurrence at a distant site was observed in 102 patients (68.5%). LN metastasis was independently associated with risk of distant recurrence (P = .002). The LN (D) and LN (D0) groups did not differ in overall survival (P = .101) or disease-free survival (P = .111). Poorly differentiated histologic grade (P = .016) and LN metastasis (P < .001) was identified as an independent predictor of overall survival. CONCLUSION: Routine LND for ICC did not show survival benefits; however, LN sampling might be useful for nodal staging, an essential factor in predicting outcome and deciding whether to apply adjuvant treatment.
Authors: Sean P Martin; Samantha Ruff; Laurence P Diggs; Justin Drake; Reed I Ayabe; Zachary J Brown; Michael M Wach; Seth M Steinberg; Jeremy L Davis; Jonathan M Hernandez Journal: HPB (Oxford) Date: 2018-08-20 Impact factor: 3.647
Authors: Diamantis I Tsilimigras; Kota Sahara; Lu Wu; Dimitrios Moris; Fabio Bagante; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Feng Shen; Olivier Soubrane; B Groot Koerkamp; Amika Moro; Kazunari Sasaki; Federico Aucejo; Xu-Feng Zhang; Ryusei Matsuyama; Itaru Endo; Timothy M Pawlik Journal: JAMA Surg Date: 2020-09-01 Impact factor: 14.766