Woohyung Lee1, Chi-Young Jeong2, Jae Yool Jang2, Young Hoon Roh3, Kwan Woo Kim3, Sung Hwa Kang3, Myung Hee Yoon4, Hyung Il Seo4, Jeong-Ik Park5, Bo-Hyun Jung5, Dong Hoon Shin6, Young Il Choi6, Hyung Hwan Moon6, Je Ho Ryu7, Kwangho Yang7, Chang Soo Choi8, Yo-Han Park8, Yang Won Nah9, Ryounggo Kim10, Jonathan Navarro11, Dae-Hoon Han11, Gi Hong Choi11, Chang Moo Kang11, Kyung-Sik Kim11, Soon-Chan Hong12. 1. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea; Department of Surgery, Asan Medical Center, Ulsan University, College of Medicine, Seoul, Republic of Korea. 2. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea. 3. Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea. 4. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University, College of Medicine, Busan, Republic of Korea. 5. Department of Surgery, College of Medicine Inje University, Haeundae Paik Hospital, Busan, Republic of Korea. 6. Department of Surgery, Kosin University Gospel Hospital, Kosin University, College of Medicine, Busan, Republic of Korea. 7. Department of Surgery, Pusan University Yangsan Hospital, Pusan University, College of Medicine, Busan, Republic of Korea. 8. Department of Surgery, College of Medicine Inje University, Busan Paik Hospital, Busan, Republic of Korea. 9. Department of Surgery, Ulsan University Hospital, Ulsan University, College of Medicine, Ulsan, Republic of Korea. 10. Department of Surgery, Dongnam Institute of Radiological & Medical Sciences, Republic of Korea. 11. Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea. 12. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea. Electronic address: hongsc@gnu.ac.kr.
Abstract
BACKGROUND: The clinical implication of lymph node (LN) dissection of intrahepatic cholangiocarcinoma (ICCA) is still controversial, and LN metastasis (LNM) based on tumor site has not been confirmed yet. METHODS: Patients who underwent curative-intent surgery at 10 tertiary referral centers were identified and divided into peripheral (PP) and near second confluence level tumor (NC) groups on the basis of the distance from the second confluence and oncological outcomes were compared. RESULTS: Of 179 patients, 121 patients with LND were divided into the NC (n = 89) and PP groups (n = 32) on the basis of 4.5 cm from the second confluence. NC group showed higher LNM rate than PP group (46.1 vs 21.9%, p = 0.016) and NC was a risk factor for LNM (odds ratio: 4.367; 95% confidence interval: 1.234-15.453, p = 0.022). The 5-year overall survival (OS) rate (38.0% vs. 27.8%, p = 0.777) and recurrence-free survival (RFS) rates (22.8% vs. 25.8%, p = 0.742) showed no differences between the PP and NC groups. In the NC group, N1 patients showed worse 5-year OS (12.7% vs 39.0%, p = 0.004) and RFS (8.8% vs 28.6%, p = 0.004) than the N0 patients. In the PP group, discordant results in 5-year OS (48.9% vs. 50.0%, p = 0.462) and RFS (41.3% vs. 0%, p = 0.056) were found between the N0 and N1 patients. CONCLUSION: The NC group was an independent risk factor for LNM and LNM worsened prognosis in NC group for ICCA. In the PP group, LND should not be omitted because of high LNM rate and insufficient oncologic evidence.
BACKGROUND: The clinical implication of lymph node (LN) dissection of intrahepatic cholangiocarcinoma (ICCA) is still controversial, and LN metastasis (LNM) based on tumor site has not been confirmed yet. METHODS:Patients who underwent curative-intent surgery at 10 tertiary referral centers were identified and divided into peripheral (PP) and near second confluence level tumor (NC) groups on the basis of the distance from the second confluence and oncological outcomes were compared. RESULTS: Of 179 patients, 121 patients with LND were divided into the NC (n = 89) and PP groups (n = 32) on the basis of 4.5 cm from the second confluence. NC group showed higher LNM rate than PP group (46.1 vs 21.9%, p = 0.016) and NC was a risk factor for LNM (odds ratio: 4.367; 95% confidence interval: 1.234-15.453, p = 0.022). The 5-year overall survival (OS) rate (38.0% vs. 27.8%, p = 0.777) and recurrence-free survival (RFS) rates (22.8% vs. 25.8%, p = 0.742) showed no differences between the PP and NC groups. In the NC group, N1 patients showed worse 5-year OS (12.7% vs 39.0%, p = 0.004) and RFS (8.8% vs 28.6%, p = 0.004) than the N0 patients. In the PP group, discordant results in 5-year OS (48.9% vs. 50.0%, p = 0.462) and RFS (41.3% vs. 0%, p = 0.056) were found between the N0 and N1 patients. CONCLUSION: The NC group was an independent risk factor for LNM and LNM worsened prognosis in NC group for ICCA. In the PP group, LND should not be omitted because of high LNM rate and insufficient oncologic evidence.