Kota Sahara1,2, Diamantis I Tsilimigras1, Katiuscha Merath1, Fabio Bagante3, Alfredo Guglielmi3, Luca Aldrighetti4, Matthew Weiss5, Todd W Bauer6, Sorin Alexandrescu7, George A Poultsides8, Shishir K Maithel9, Hugo P Marques10, Guillaume Martel11, Carlo Pulitano12, Feng Shen13, Olivier Soubrane14, B Groot Koerkamp15, Ryusei Matsuyama2, Itaru Endo2, Timothy M Pawlik16,17. 1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 2. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 3. Department of Surgery, University of Verona, Verona, Italy. 4. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 5. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 6. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 7. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 8. Department of Surgery, Stanford University, Stanford, CA, USA. 9. Department of Surgery, Emory University, Atlanta, GA, USA. 10. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 11. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 12. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia. 13. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 14. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 15. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 16. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. Tim.Pawlik@osumc.edu. 17. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. Tim.Pawlik@osumc.edu.
Abstract
BACKGROUND: Although lymph node metastasis (LNM) is an important prognostic indicator for patients with intrahepatic cholangiocarcinoma (ICC), the benefit and indication for lymphadenectomy remain unclear. METHODS: Patients diagnosed with ICC between 1990 and 2016 were identified in the international multi-institutional dataset. To determine the survival benefit from lymphadenectomy, the therapeutic index was calculated by multiplying the frequency of LNM in a particular group of patients by the 3-year cancer-specific survival (CSS) rate of patients with LNM in that subgroup. RESULTS: Among 471 patients who met the inclusion criteria, approximately half had LNM (n = 205, 43.5%). The median number of resected and metastatic LNs were 4 [interquartile range (IQR) 2-8] and 0 (IQR 0-1), respectively. Three-year CSS in the entire cohort was 29.9%, reflecting a therapeutic index value of 13.0. The therapeutic index was lower among patients with major vascular invasion (5.4), preoperative carcinoembryonic antigen (CEA) > 5.0 (8.2), and LNM in areas other than the hepatoduodenal ligament (5.2). Of note, a therapeutic index difference of more than 10 points was noted only when examining the number of LNs harvested [1-2 (4.1) vs. 3-6 (16.1) vs. ≥ 7 (17.8)]. CONCLUSION: The survival benefit derived from lymphadenectomy was poor among patients with major vascular invasion, CEA > 5.0, and LNM in areas other than the hepatoduodenal ligament. Resection of three or more LNs was associated with the highest therapeutic value among patients with LNM.
BACKGROUND: Although lymph node metastasis (LNM) is an important prognostic indicator for patients with intrahepatic cholangiocarcinoma (ICC), the benefit and indication for lymphadenectomy remain unclear. METHODS:Patients diagnosed with ICC between 1990 and 2016 were identified in the international multi-institutional dataset. To determine the survival benefit from lymphadenectomy, the therapeutic index was calculated by multiplying the frequency of LNM in a particular group of patients by the 3-year cancer-specific survival (CSS) rate of patients with LNM in that subgroup. RESULTS: Among 471 patients who met the inclusion criteria, approximately half had LNM (n = 205, 43.5%). The median number of resected and metastatic LNs were 4 [interquartile range (IQR) 2-8] and 0 (IQR 0-1), respectively. Three-year CSS in the entire cohort was 29.9%, reflecting a therapeutic index value of 13.0. The therapeutic index was lower among patients with major vascular invasion (5.4), preoperative carcinoembryonic antigen (CEA) > 5.0 (8.2), and LNM in areas other than the hepatoduodenal ligament (5.2). Of note, a therapeutic index difference of more than 10 points was noted only when examining the number of LNs harvested [1-2 (4.1) vs. 3-6 (16.1) vs. ≥ 7 (17.8)]. CONCLUSION: The survival benefit derived from lymphadenectomy was poor among patients with major vascular invasion, CEA > 5.0, and LNM in areas other than the hepatoduodenal ligament. Resection of three or more LNs was associated with the highest therapeutic value among patients with LNM.
Authors: Kota Sahara; Diamantis I Tsilimigras; Shishir K Maithel; Daniel E Abbott; George A Poultsides; Ioannis Hatzaras; Ryan C Fields; Matthew Weiss; Charles Scoggins; Chelsea A Isom; Kamran Idrees; Perry Shen; Itaru Endo; Timothy M Pawlik Journal: J Surg Oncol Date: 2020-01-06 Impact factor: 2.885