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Extent of Lymph Node Dissection for Accurate Staging in Intrahepatic Cholangiocarcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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Acknowledgements

The authors thank Medical Illustration & Design, part of the Medical Research Support Services of Yonsei University College of Medicine, for all artistic support related to this work.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Sung Hyun Kim, Dai Hoon Han, Gi Hong Choi, Jin Sub Choi & Kyung Sik Kim

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  1. Sung Hyun Kim
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  2. Dai Hoon Han
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Contributions

Sung Hyun Kim: design of the work, analysis of data, and drafting the work. Dai Hoon Han: acquisition of data and agreement to be accountable for all aspects of the work. Gi Hong Choi: acquisition of data and agreement to be accountable for all aspects of the work. Jin Sub Choi: acquisition of data and agreement to be accountable for all aspects of the work. Kyung Sik Kim: critical revision and final approval of the version to be published.

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Correspondence to Kyung Sik Kim.

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Kim, S.H., Han, D.H., Choi, G.H. et al. Extent of Lymph Node Dissection for Accurate Staging in Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 26, 70–76 (2022). https://doi.org/10.1007/s11605-021-05039-5

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  • DOI: https://doi.org/10.1007/s11605-021-05039-5

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