Tomoaki Yoh1, François Cauchy2, Bertrand Le Roy2, Satoru Seo3, Kojiro Taura3, Christian Hobeika2, Safi Dokmak2, Oliver Farges2, Maximiliano Gelli2, Antonio Sa Cunha4, René Adam4, Shinji Uemoto3, Olivier Soubrane5. 1. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, Clichy, Assistance Publique, Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France; Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, Clichy, Assistance Publique, Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. 3. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Université Paris-Sud, Institut National de la Santé et de la Recherche Médicale U935, Villejuif, France. 5. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, Clichy, Assistance Publique, Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. Electronic address: olivier.soubrane@aphp.fr.
Abstract
BACKGROUND: Lymphadenectomy ensures accurate staging for patients with intrahepatic cholangiocarcinoma, especially for those without preoperatively suspected positive lymph nodes (clinically node-negative); however, its prognostic value has been poorly documented. The aim of this study was to evaluate the prognostic value of lymphadenectomy on long-term outcomes in patients undergoing surgery for clinically node-negative intrahepatic cholangiocarcinoma. METHODS: Data from all patients who underwent liver resection with or without lymphadenectomy for preoperatively diagnosed intrahepatic cholangiocarcinoma between 2000 and 2016 at 3 tertiary hepatobiliary centers were analyzed retrospectively. Propensity score matching in a 1:1 ratio was conducted based on clinically relevant covariates between patients with clinically node-negative intrahepatic cholangiocarcinoma who underwent liver resection with (LND group) and without (NLND group) lymphadenectomy. Overall survival and disease-free survival were compared in the matched cohort. RESULTS: Among 350 patients who underwent surgery during the study period, 192 (55%) with clinically node-negative intrahepatic cholangiocarcinoma met the inclusion criteria. After propensity score matching, 2 well-balanced groups of 56 patients each were analyzed. There was no significant difference regarding postoperative variables among these 112 matched patients. Patients who underwent a liver resection with lymphadenectomy achieved better 3- and 5-year overall survival (78% and 65% vs 52% and 46%, P = .017) and disease-free survival (46% and 34% vs 31% and 31%; P = .042) compared with patients who underwent liver resection without lymphadenectomy. CONCLUSION: Lymphadenectomy can be associated with better long-term outcomes in patients with node-negative intrahepatic cholangiocarcinoma. Our data may support routine lymphadenectomy for node-negative intrahepatic cholangiocarcinoma with the objective of achieving better long-term outcomes.
BACKGROUND: Lymphadenectomy ensures accurate staging for patients with intrahepatic cholangiocarcinoma, especially for those without preoperatively suspected positive lymph nodes (clinically node-negative); however, its prognostic value has been poorly documented. The aim of this study was to evaluate the prognostic value of lymphadenectomy on long-term outcomes in patients undergoing surgery for clinically node-negative intrahepatic cholangiocarcinoma. METHODS: Data from all patients who underwent liver resection with or without lymphadenectomy for preoperatively diagnosed intrahepatic cholangiocarcinoma between 2000 and 2016 at 3 tertiary hepatobiliary centers were analyzed retrospectively. Propensity score matching in a 1:1 ratio was conducted based on clinically relevant covariates between patients with clinically node-negative intrahepatic cholangiocarcinoma who underwent liver resection with (LND group) and without (NLND group) lymphadenectomy. Overall survival and disease-free survival were compared in the matched cohort. RESULTS: Among 350 patients who underwent surgery during the study period, 192 (55%) with clinically node-negative intrahepatic cholangiocarcinoma met the inclusion criteria. After propensity score matching, 2 well-balanced groups of 56 patients each were analyzed. There was no significant difference regarding postoperative variables among these 112 matched patients. Patients who underwent a liver resection with lymphadenectomy achieved better 3- and 5-year overall survival (78% and 65% vs 52% and 46%, P = .017) and disease-free survival (46% and 34% vs 31% and 31%; P = .042) compared with patients who underwent liver resection without lymphadenectomy. CONCLUSION: Lymphadenectomy can be associated with better long-term outcomes in patients with node-negative intrahepatic cholangiocarcinoma. Our data may support routine lymphadenectomy for node-negative intrahepatic cholangiocarcinoma with the objective of achieving better long-term outcomes.