X-F Zhang1,2, J Chakedis2, F Bagante3, Q Chen2, E W Beal2, Y Lv1, M Weiss4, I Popescu5, H P Marques6, L Aldrighetti7, S K Maithel8, C Pulitano9, T W Bauer10, F Shen11, G A Poultsides12, O Soubrane13, G Martel14, B Groot Koerkamp15, A Guglielmi3, E Itaru16, T M Pawlik2. 1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 3. Department of Surgery, University of Verona, Verona, Italy. 4. Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. 5. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 6. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 7. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 8. Department of Surgery, Emory University, Atlanta, Georgia, USA. 9. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia. 10. Department of Surgery, University of Virginia, Charlottesville, Virginia, USA. 11. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 12. Department of Surgery, Stanford University, Stanford, California, USA. 13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Assistance Publique - Hôpitaux de Paris, Beaujon Hospital, Clichy, France. 14. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. 15. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 16. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan.
Abstract
BACKGROUND: The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC. METHODS: Patients undergoing curative intent resection for ICC in 2000-2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories. RESULTS: Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM. CONCLUSION: The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.
BACKGROUND: The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC. METHODS:Patients undergoing curative intent resection for ICC in 2000-2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories. RESULTS: Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM. CONCLUSION: The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.
Authors: Lu Wu; Diamantis I Tsilimigras; Anghela Z Paredes; Rittal Mehta; J Madison Hyer; Katiuscha Merath; Kota Sahara; Fabio Bagante; Eliza W Beal; Feng Shen; Timothy M Pawlik Journal: World J Surg Date: 2019-07 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
Authors: Daniel R Waisberg; Rafael S Pinheiro; Lucas S Nacif; Vinicius Rocha-Santos; Rodrigo B Martino; Rubens M Arantes; Liliana Ducatti; Quirino Lai; Wellington Andraus; Luiz C D'Albuquerque Journal: Transl Gastroenterol Hepatol Date: 2018-09-12