Fabio Bagante1, Gaya Spolverato1, Matthew Weiss2, Sorin Alexandrescu3, Hugo P Marques4, Luca Aldrighetti5, Shishir K Maithel6, Carlo Pulitano7, Todd W Bauer8, Feng Shen9, George A Poultsides10, Oliver Soubrane11, Guillaume Martel12, B Groot Koerkamp13, Alfredo Guglielmi1, Endo Itaru14, Timothy M Pawlik15. 1. Department of Surgery, University of Verona, Verona, Italy. 2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 3. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 5. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 6. Department of Surgery, Emory University, Atlanta, GA, USA. 7. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 8. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 9. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 10. Department of Surgery, Stanford University, Stanford, CA, USA. 11. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 12. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 13. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 14. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. 15. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.
Abstract
INTRODUCTION: The role of routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) is still controversial. The AJCC eighth edition recommends a minimum of six harvested lymph nodes (HLNs) for adequate nodal staging. We sought to define outcome and risk of death among patients who were staged with ≥6 HLNs versus <6 HLNs. MATERIALS AND METHODS: Patients undergoing hepatectomy for ICC between 1990 and 2015 at 1 of the 14 major hepatobiliary centers were identified. RESULTS: Among 1154 patients undergoing hepatectomy for ICC, 515 (44.6%) had lymphadenectomy. On final pathology, 200 (17.3%) patients had metastatic lymph node (MLN), while 315 (27.3%) had negative lymph node (NLN). Among NLN patients, HLN was associated with 5-year OS (p = 0.098). While HLN did not impact 5-year OS among MLN patients (p = 0.71), the number of MLN was associated with 5-year OS (p = 0.02). Among the 317 (27.5%) patients staged according the AJCC eighth edition staging system, N1 patients had a 3-fold increased risk of death compared with N0 patients (hazard ratio 3.03; p < 0.001). CONCLUSION: Only one fourth of patients undergoing hepatectomy for ICC had adequate nodal staging according to the AJCC eighth edition. While the six HLN cutoff value impacted prognosis of N0 patients, the number of MLN rather than HLN was associated with long-term survival of N1 patients.
INTRODUCTION: The role of routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) is still controversial. The AJCC eighth edition recommends a minimum of six harvested lymph nodes (HLNs) for adequate nodal staging. We sought to define outcome and risk of death among patients who were staged with ≥6 HLNs versus <6 HLNs. MATERIALS AND METHODS:Patients undergoing hepatectomy for ICC between 1990 and 2015 at 1 of the 14 major hepatobiliary centers were identified. RESULTS: Among 1154 patients undergoing hepatectomy for ICC, 515 (44.6%) had lymphadenectomy. On final pathology, 200 (17.3%) patients had metastatic lymph node (MLN), while 315 (27.3%) had negative lymph node (NLN). Among NLN patients, HLN was associated with 5-year OS (p = 0.098). While HLN did not impact 5-year OS among MLN patients (p = 0.71), the number of MLN was associated with 5-year OS (p = 0.02). Among the 317 (27.5%) patients staged according the AJCC eighth edition staging system, N1 patients had a 3-fold increased risk of death compared with N0 patients (hazard ratio 3.03; p < 0.001). CONCLUSION: Only one fourth of patients undergoing hepatectomy for ICC had adequate nodal staging according to the AJCC eighth edition. While the six HLN cutoff value impacted prognosis of N0 patients, the number of MLN rather than HLN was associated with long-term survival of N1 patients.
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