Background

Although lymph node metastasis is a known factor predictive of a poor prognosis after radical surgery for intrahepatic cholangiocarcinoma (ICC), few studies have investigated lymph node dissection (LND) areas for accurate staging. The aim of this study was to identify the optimal LND level for ICC considering lymphatic flow.

Methods

Clinical characteristics and pathologic nodal status (presence of metastasis) for 163 patients were reviewed according to tumor location. In the node-positive (N1) group, the distribution of metastatic nodes was described. The coverage of metastatic nodes according to dissection level was assessed, and the minimum dissection level for accurate ICC staging was estimated accordingly. For validation, the node-negative (N0) group was divided into two subgroups according to the estimated dissection level, and survival outcomes were compared.

Results

In the N1 group, expanding dissection to stations no. 12 and 8 covered 82.0% (n = 50) of metastatic cases regardless of tumor location. In survival analysis of N0 group, patients who underwent LND covering stations no. 8+12 showed better disease-free survival (DFS) and overall survival (OS), although the differences were not statistically significant (DFS: covering no. 12+8 vs. not covering no. 12+8, 109.0 months [24.2–193.8] vs. 33.0 months [10.3–55.7], p = 0.078; OS: covering no. 12+8 vs. not covering no. 12+8, 180.0 months [21.6–338.4] vs. 73.0 months [42.8–103.2], p = 0.080).

Conclusion

LND including at least stations no. 12 (hepatoduodenal ligament) and 8 (common hepatic artery), regardless of tumor location, is recommended for accurate staging in ICC patients.

中文翻译：

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肝内胆管癌准确分期淋巴结清扫范围

背景

尽管淋巴结转移是预测肝内胆管癌 (ICC) 根治性手术后预后不良的已知因素，但很少有研究调查淋巴结清扫 (LND) 区域以进行准确分期。本研究的目的是确定考虑淋巴流动的 ICC 的最佳 LND 水平。

方法

根据肿瘤位置回顾了 163 名患者的临床特征和病理淋巴结状态（是否存在转移）。在淋巴结阳性 (N1) 组中，描述了转移淋巴结的分布。根据解剖水平评估转移淋巴结的覆盖率，并据此估计准确 ICC 分期的最小解剖水平。为了验证，根据估计的解剖水平将淋巴结阴性（N0）组分为两个亚组，并比较生存结果。

结果

在 N1 组中，将解剖扩大到站号。12 和 8 覆盖了 82.0% ( n = 50) 的转移病例，无论肿瘤位置如何。在 N0 组生存分析中，接受 LND 覆盖站的患者没有。8+12 显示出更好的无病生存期 (DFS) 和总生存期 (OS)，尽管差异无统计学意义（DFS：覆盖第 12+8 号与不覆盖第 12+8 号，109.0 个月 [24.2– 193.8] 与 33.0 个月 [10.3–55.7]，p = 0.078；OS：覆盖 12+8 与不覆盖 12+8，180.0 个月 [21.6–338.4] 与 73.0 个月 [42.8–103.2] , p = 0.080)。

结论

LND 至少包括站号。12（肝十二指肠韧带）和 8（肝总动脉），无论肿瘤位置如何，都推荐用于 ICC 患者的准确分期。