TY - JOUR
T1 - The impact of tumor location on the value of lymphadenectomy for intrahepatic cholangiocarcinoma
AU - Endo, Yutaka
AU - Moazzam, Zorays
AU - Lima, Henrique A.
AU - Alaimo, Laura
AU - Munir, Muhammad M.
AU - Shaikh, Chanza F.
AU - Guglielmi, Alfredo
AU - Aldrighetti, Luca
AU - Weiss, Matthew
AU - Bauer, Todd W.
AU - Alexandrescu, Sorin
AU - Poultsides, George A.
AU - Kitago, Minoru
AU - Maithel, Shishir K.
AU - Marques, Hugo P.
AU - Martel, Guillaume
AU - Pulitano, Carlo
AU - Shen, Feng
AU - Cauchy, François
AU - Koerkamp, Bas G.
AU - Endo, Itaru
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2023 International Hepato-Pancreato-Biliary Association Inc.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
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U2 - 10.1016/j.hpb.2023.02.013
DO - 10.1016/j.hpb.2023.02.013
M3 - Article
C2 - 36894491
AN - SCOPUS:85149957246
SN - 1365-182X
JO - HPB
JF - HPB
ER -