Surgical resection is the only potentially curative treatment for patients with resectable perihilar cholangiocarcinoma (PHC). There is still no consensus on the value of lymphadenectomy despite evidence indicating lymph node (LN) status is an important prognostic indicator for postoperative long-term survival. We sought to perform a meta-analysis to summarize the current evidence on the value of lymphadenectomy among patients undergoing surgery for PHC. The PubMed (OvidSP), Embase and Cochrane Library were systematically searched for studies published before July 2020 that reported on lymphadenectomy at the time of surgery for PHC after curative surgery. 7748 patients from 28 studies were included in the meta-analysis. No survival benefit was identified with increased number of LN resected (all P > 0.05). Meanwhile, overall LN status was an important prognostic factor. Patients with lymph node metastasis had a pooled estimate hazard ratio of death that was over two-fold higher than patients without lymph node metastasis (HR 2.07, 95% CI 1.65–2.59, P < 0.001). The examination of 5 LNs on histology was associated with better staging of lymph node status and stratification of patients into positive or negative LN groups. While the extent of LN dissection was not associated with a survival benefit, examination of more than 5 LNs better staged patients into positive or negative LN groups with a lower risk of nodal understaging.

对于可切除的肝门部胆管癌 (PHC) 患者，手术切除是唯一可能治愈的治疗方法。尽管有证据表明淋巴结 (LN) 状态是术后长期生存的重要预后指标，但对淋巴结切除术的价值仍未达成共识。我们试图进行一项荟萃分析，以总结有关接受 PHC 手术的患者进行淋巴结清扫术价值的当前证据。系统搜索了 PubMed (OvidSP)、Embase 和 Cochrane 图书馆，以查找 2020 年 7 月之前发表的研究，这些研究报告了根治性手术后 PHC 手术时的淋巴结切除术。来自 28 项研究的 7748 名患者被纳入荟萃分析。淋巴结切除数量的增加没有确定生存获益（所有P  > 0.05）。同时，整体 LN 状态是一个重要的预后因素。淋巴结转移患者的合并估计死亡风险比比无淋巴结转移患者高两倍以上（HR 2.07，95% CI 1.65–2.59，P  < 0.001）。在组织学上检查 5 个 LN 与更好的淋巴结状态分期和患者分层为阳性或阴性 LN 组相关。虽然 LN 夹层的程度与生存获益无关，但检查超过 5 个 LN 可以更好地将患者分期为阳性或阴性 LN 组，淋巴结分期不足的风险较低。