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The impact of tumor location on the value of lymphadenectomy for intrahepatic cholangiocarcinoma. HPB : the official journal of the International Hepato Pancreato Biliary Association Endo, Y., Moazzam, Z., Lima, H. A., Alaimo, L., Munir, M. M., Shaikh, C. F., Guglielmi, A., Aldrighetti, L., Weiss, M., Bauer, T. W., Alexandrescu, S., Poultsides, G. A., Kitago, M., Maithel, S. K., Marques, H. P., Martel, G., Pulitano, C., Shen, F., Cauchy, F., Koerkamp, B. G., Endo, I., Pawlik, T. M. 2023

Abstract

BACKGROUND: The therapeutic role of lymphadenectomy (LND) for intrahepatic cholangiocarcinoma (ICC) patients remains ill-defined. We sought to analyze the therapeutic value of LND relative to tumor location and preoperative lymph node metastasis (LNM) risk.METHODS: Patients who underwent curative-intent hepatic resection of ICC between 1990 and 2020 were included from a multi-institutional database. Therapeutic LND (tLND) was defined as LND that harvested =3 lymph nodes.RESULTS: Among 662 patients, 178 (26.9%) individuals received tLND. Patients were categorized into central type ICC (n=156, 23.6%) and peripheral type ICC (n=506, 76.4%). Central type harbored multiple adverse clinicopathologic factors and worse overall survival (OS) compared with peripheral type (5-year OS, central: 27.0% vs. peripheral: 47.2%, p<0.001). After consideration of preoperative LNM risk, patients with central type and high-risk LNM who underwent tLND survived longer than individuals who did not (5-year OS, tLND: 27.9% vs. non-tLND: 9.0%, p=0.001), whereas tLND was not associated with better survival among patients with peripheral type ICC or low-risk LNM. The therapeutic index of hepatoduodenal ligament (HDL) and other regions was higher in central type than in peripheral type, which was more pronounced among high-risk LNM patients.CONCLUSIONS: Central type ICC with high-risk LNM should undergo LND involving regions beyond the HDL.

View details for DOI 10.1016/j.hpb.2023.02.013

View details for PubMedID 36894491