Wen-Jie Ma1,2, Zheng-Ru Wu2, Hai-Jie Hu1, Jun-Ke Wang1, Chang-Hao Yin1, Yu-Jun Shi2, Fu-Yu Li3, Nan-Sheng Cheng4. 1. Department of Biliary Surgery, West China Hospital of Medicine, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. 2. Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, China. 3. Department of Biliary Surgery, West China Hospital of Medicine, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. lfy_74@hotmail.com. 4. Department of Biliary Surgery, West China Hospital of Medicine, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. nanshengcheng2014@hotmail.com.
Abstract
AIM: The aim of this study is to compare the effects of extended lymphadenectomy (E-LD) and regional lymphadenectomy (R-LD) on outcome after radical resection of hilar cholangiocarcinoma (HCCA). METHODS: Data of 290 patients who underwent radical resection of HCCA were retrospectively analyzed. Demographic characteristics, surgical variables, and tumor and LN characteristics were evaluated for association with survival. RESULTS: A total of 63 patients underwent E-LD. Patients who underwent E-LD were more likely to have portal vein embolization (14.3% vs. 5.7%), radical hepatectomy (36.2% vs. 26.0%), higher proportion of M1 patients (22.2% vs. 5.3%), more lymph nodes (LNs) retrieved (17 vs. 7), and positive common hepatic artery lymph nodes (21.4% vs. 12.6%) when compared with R-LD (all P < 0.05). The Kaplan-Meier curve of overall survival for patients who underwent E-LD indicated improvement over patients who underwent R-LD in M0 (33.39 vs. 21.31 months; P = 0.032) and R0 resection (32.97 vs. 21.02 months; P = 0.044) disease, but not observed in M1 disease (P > 0.05). After propensity score matching, E-LD was not associated with a significant improvement in overall survival (OS) even in all subgroup analysis (all P > 0.05). On multivariable analysis, E-LD was associated with improved overall survival, but not after propensity score matching. CONCLUSION: E-LD is more likely to be performed in higher stage tumors. E-LD significantly increases LN retrieval, thereby preventing under-staging and improving survival prediction. E-LD should not be adopted for HCCA patients with intraoperatively confirmed distant LN metastases. Future studies are required to further assess whether E-LD should be performed in negative celiac, superior mesenteric, and para-aortic lymph node in HCCA patients.
AIM: The aim of this study is to compare the effects of extended lymphadenectomy (E-LD) and regional lymphadenectomy (R-LD) on outcome after radical resection of hilar cholangiocarcinoma (HCCA). METHODS: Data of 290 patients who underwent radical resection of HCCA were retrospectively analyzed. Demographic characteristics, surgical variables, and tumor and LN characteristics were evaluated for association with survival. RESULTS: A total of 63 patients underwent E-LD. Patients who underwent E-LD were more likely to have portal vein embolization (14.3% vs. 5.7%), radical hepatectomy (36.2% vs. 26.0%), higher proportion of M1 patients (22.2% vs. 5.3%), more lymph nodes (LNs) retrieved (17 vs. 7), and positive common hepatic artery lymph nodes (21.4% vs. 12.6%) when compared with R-LD (all P < 0.05). The Kaplan-Meier curve of overall survival for patients who underwent E-LD indicated improvement over patients who underwent R-LD in M0 (33.39 vs. 21.31 months; P = 0.032) and R0 resection (32.97 vs. 21.02 months; P = 0.044) disease, but not observed in M1 disease (P > 0.05). After propensity score matching, E-LD was not associated with a significant improvement in overall survival (OS) even in all subgroup analysis (all P > 0.05). On multivariable analysis, E-LD was associated with improved overall survival, but not after propensity score matching. CONCLUSION: E-LD is more likely to be performed in higher stage tumors. E-LD significantly increases LN retrieval, thereby preventing under-staging and improving survival prediction. E-LD should not be adopted for HCCA patients with intraoperatively confirmed distant LN metastases. Future studies are required to further assess whether E-LD should be performed in negative celiac, superior mesenteric, and para-aortic lymph node in HCCA patients.
Authors: Lynn E Nooijen; Jesus M Banales; Marieke T de Boer; Chiara Braconi; Trine Folseraas; Alejandro Forner; Waclaw Holowko; Frederik J H Hoogwater; Heinz-Josef Klümpen; Bas Groot Koerkamp; Angela Lamarca; Adelaida La Casta; Flora López-López; Laura Izquierdo-Sánchez; Alexander Scheiter; Kirsten Utpatel; Rutger-Jan Swijnenburg; Geert Kazemier; Joris I Erdmann Journal: Cancers (Basel) Date: 2022-05-12 Impact factor: 6.575
Authors: Lynn E Nooijen; Rutger-Jan Swijnenburg; Heinz-Josef Klümpen; Joanne Verheij; Geert Kazemier; Thomas M van Gulik; Joris I Erdmann Journal: Visc Med Date: 2021-01-07
Authors: Tommaso M Manzia; Alessandro Parente; Ilaria Lenci; Bruno Sensi; Martina Milana; Carlo Gazia; Alessandro Signorello; Roberta Angelico; Giuseppe Grassi; Giuseppe Tisone; Leonardo Baiocchi Journal: World J Gastrointest Oncol Date: 2021-12-15