Fabio Bagante1, Faiz Gani1, Gaya Spolverato1, Li Xu1, Sorin Alexandrescu2, Hugo P Marques3, Jorge Lamelas3, Luca Aldrighetti4, T Clark Gamblin5, Shishir K Maithel6, Carlo Pulitano7, Todd W Bauer8, Feng Shen9, George A Poultsides10, J Wallis Marsh11, Timothy M Pawlik12. 1. the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2. Fundeni Clinical Institute, Bucharest, Romania. 3. Curry Cabral Hospital, Lisbon, Portugal. 4. Ospedale San Raffaele, Milan, Italy. 5. Medical College of Wisconsin, Milwaukee, WI. 6. Emory University, Atlanta, GA. 7. University of Sydney, Sydney, Australia. 8. University of Virginia, Charlottesville, VA. 9. Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 10. Stanford University, Stanford, CA. 11. University of Pittsburgh Medical Center, Pittsburgh, PA. 12. the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
Abstract
BACKGROUND: The role of routine lymphadenectomy (LD) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) remains poorly defined. This study aimed to evaluate the role of routine LD as well as to quantify the impact of not assessing nodal station on disease-specific survival (DSS) among patients undergoing liver surgery for ICC. STUDY DESIGN: Using data from 12 major hepatobiliary centers, 561 patients undergoing liver surgery for ICC between 1990 and 2012 were identified. The association between nodal status and DSS was assessed using Cox proportional and Aalen's linear hazards models. RESULTS: Among the 272 (48.5%) patients who underwent LD, 123 (45.2%) had lymph node metastasis (N1). Although differences in DSS were noted between N0 and Nx patients within the first 18 months after surgery (DSS at 18 months: N0 vs Nx, 70.2% vs 60.6%, respectively, p = 0.019) among patients who had survived to 18 months, the DSS at 60 months of Nx patients was comparable to that of N0 patients (p = 0.48). Conversely, although the DSS of N1 and Nx patients was comparable in the short-term (DSS at 18 months: p = 0.13), among patients who had survived to 18 months, N1 patients had a lower DSS compared with Nx patients (DSS at 60 months among patients who had survived to 18 months: N1 vs Nx, 15.2% vs 45.8%, respectively, p < 0.001; all p values were based on the log-rank test comparing 2 survival curves). CONCLUSIONS: Although Nx patients and N1 patients had comparable DSS in the short-term, Nx patients who survived past 18 months had a survival comparable to that of N0 patients. Lack of nodal staging may lead to heterogeneous and potentially incorrect prognostic classification of patients with ICC.
BACKGROUND: The role of routine lymphadenectomy (LD) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) remains poorly defined. This study aimed to evaluate the role of routine LD as well as to quantify the impact of not assessing nodal station on disease-specific survival (DSS) among patients undergoing liver surgery for ICC. STUDY DESIGN: Using data from 12 major hepatobiliary centers, 561 patients undergoing liver surgery for ICC between 1990 and 2012 were identified. The association between nodal status and DSS was assessed using Cox proportional and Aalen's linear hazards models. RESULTS: Among the 272 (48.5%) patients who underwent LD, 123 (45.2%) had lymph node metastasis (N1). Although differences in DSS were noted between N0 and Nx patients within the first 18 months after surgery (DSS at 18 months: N0 vs Nx, 70.2% vs 60.6%, respectively, p = 0.019) among patients who had survived to 18 months, the DSS at 60 months of Nx patients was comparable to that of N0 patients (p = 0.48). Conversely, although the DSS of N1 and Nx patients was comparable in the short-term (DSS at 18 months: p = 0.13), among patients who had survived to 18 months, N1 patients had a lower DSS compared with Nx patients (DSS at 60 months among patients who had survived to 18 months: N1 vs Nx, 15.2% vs 45.8%, respectively, p < 0.001; all p values were based on the log-rank test comparing 2 survival curves). CONCLUSIONS: Although Nx patients and N1 patients had comparable DSS in the short-term, Nx patients who survived past 18 months had a survival comparable to that of N0 patients. Lack of nodal staging may lead to heterogeneous and potentially incorrect prognostic classification of patients with ICC.
Authors: Xu-Feng Zhang; Eliza W Beal; Jeffery Chakedis; Qinyu Chen; Yi Lv; Cecilia G Ethun; Ahmed Salem; Sharon M Weber; Thuy Tran; George Poultsides; Andre Y Son; Ioannis Hatzaras; Linda Jin; Ryan C Fields; Stefan Buettner; Charles Scoggins; Robert C G Martin; Chelsea A Isom; Kamron Idrees; Harveshp D Mogal; Perry Shen; Shishir K Maithel; Carl R Schmidt; Timothy M Pawlik Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Fabio Bagante; Gaya Spolverato; Matthew Weiss; Sorin Alexandrescu; Hugo P Marques; Luca Aldrighetti; Shishir K Maithel; Carlo Pulitano; Todd W Bauer; Feng Shen; George A Poultsides; Oliver Soubrane; Guillaume Martel; B Groot Koerkamp; Alfredo Guglielmi; Endo Itaru; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2017-04-19 Impact factor: 3.452
Authors: Fabio Bagante; Gaya Spolverato; Matthew Weiss; Sorin Alexandrescu; Hugo P Marques; Luca Aldrighetti; Shishir K Maithel; Carlo Pulitano; Todd W Bauer; Feng Shen; George A Poultsides; Oliver Soubrane; Guillaume Martel; B Groot Koerkamp; Alfredo Guglielmi; Endo Itaru; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2017-08-24 Impact factor: 3.452
Authors: Fabio Bagante; Gaya Spolverato; Matthew Weiss; Sorin Alexandrescu; Hugo P Marques; Luca Aldrighetti; Shishir K Maithel; Carlo Pulitano; Todd W Bauer; Feng Shen; George A Poultsides; Olivier Soubrane; Guillaume Martel; B Groot Koerkamp; Alfredo Guglielmi; Endo Itaru; Andrea Ruzzenente; Timothy M Pawlik Journal: World J Surg Date: 2018-08 Impact factor: 3.352
Authors: Katiuscha Merath; Qinyu Chen; Fabio Bagante; Sorin Alexandrescu; Hugo P Marques; Luca Aldrighetti; Shishir K Maithel; Carlo Pulitano; Matthew J Weiss; Todd W Bauer; Feng Shen; George A Poultsides; Olivier Soubrane; Guillaume Martel; B Groot Koerkamp; Alfredo Guglielmi; Endo Itaru; Jordan M Cloyd; Timothy M Pawlik Journal: JAMA Surg Date: 2019-06-19 Impact factor: 14.766