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Published in: Journal of Gastrointestinal Surgery 6/2019

01-06-2019 | Metastasis | 2018 SSAT Plenary Presentation

Role of Lymph Node Dissection in Small (≤ 3 cm) Intrahepatic Cholangiocarcinoma

Authors: Andrea Ruzzenente, Simone Conci, Luca Viganò, Giorgio Ercolani, Serena Manfreda, Fabio Bagante, Andrea Ciangherotti, Corrado Pedrazzani, Antonio D. Pinna, Calogero Iacono, Guido Torzilli, Alfredo Guglielmi

Published in: Journal of Gastrointestinal Surgery | Issue 6/2019

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Abstract

Background and Aims

The role of lymph node dissection (LND) in patients with small intrahepatic cholangiocarcinoma (ICC) is still under debate.
The aims of this study were to compare the lymph node (LN) status and its correlation with survival among patients with ICC stratified by tumor size.

Methods

A retrospective analysis of a multi-institutional series of 259 patients undergoing curative-intent surgery was carried out. Patients were stratified into Small-ICC (≤ 3 cm) and Large-ICC (> 3 cm) based on tumor size.

Results

There were 53 and 206 patients in Small-ICC and Large-ICC groups, respectively. The incidence of LND was 62% among Small-ICC patients and 78% among Large-ICC patients (p = 0.016). LN metastases were identified in 30.3% and 38.5% of Small-ICC and Large-ICC patients, respectively (p = 0.37). No differences in terms of number of harvested LN and LN metastases were identified comparing Small- and Large-ICC patients. The 5-year overall survival (OS) was 52.6% for Small-ICC and 36.2% for Large-ICC (p = 0.024). The 5-year OS according to the LN status (N0 vs N+) was 84.8% and 36.0% (p = 0.032) in Small-ICC, and 45.7% and 12.1% in Large-ICC (p < 0.001), respectively.

Conclusion

While Small-ICC patients with no LN metastasis had a good long-term survival, the LN resulted in an important variable associated with survival also for patients in this group. Moreover, the incidence of LN metastasis did not differ when comparing Small-ICC and Large-ICC patients, suggesting that LND is mandatory in the surgical treatment of ICC regardless of tumor size.
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Literature
2.
go back to reference Shaib YH, Davila JA, McGlynn K, El-Serag HB. Rising incidence of intrahepatic cholangiocarcinoma in the United States: A true increase? J Hepatol 2004;40(3):472–477.CrossRefPubMed Shaib YH, Davila JA, McGlynn K, El-Serag HB. Rising incidence of intrahepatic cholangiocarcinoma in the United States: A true increase? J Hepatol 2004;40(3):472–477.CrossRefPubMed
3.
go back to reference William C. Palmer, MD and Tushar Patel. Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol 2012;57(1):69–76.CrossRef William C. Palmer, MD and Tushar Patel. Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol 2012;57(1):69–76.CrossRef
4.
go back to reference Ruzzenente A, Conci S, Valdegamberi A, Pedrazzani C, Guglielmi A. Role of surgery in the treatment of intrahepatic cholangiocarcinoma. Eur Rev Med Pharmacol Sci 2015;19(15):2892–900.PubMed Ruzzenente A, Conci S, Valdegamberi A, Pedrazzani C, Guglielmi A. Role of surgery in the treatment of intrahepatic cholangiocarcinoma. Eur Rev Med Pharmacol Sci 2015;19(15):2892–900.PubMed
5.
go back to reference de Jong M.C., Nathan H., Sotiropoulos G.C., Paul A., Alexandrescu S., Marques H. et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 2011;29:3140–3145.CrossRefPubMed de Jong M.C., Nathan H., Sotiropoulos G.C., Paul A., Alexandrescu S., Marques H. et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 2011;29:3140–3145.CrossRefPubMed
6.
go back to reference Bagante F., Spolverato G.; Weiss M., Alexandrescu s., Marques H., Aldrighetti L. et al. Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 2017; 21:1888–1897.CrossRefPubMed Bagante F., Spolverato G.; Weiss M., Alexandrescu s., Marques H., Aldrighetti L. et al. Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 2017; 21:1888–1897.CrossRefPubMed
7.
go back to reference Spolverato G, Kim Y, Ejaz A, Alexandrescu S, Marques H, Aldrighetti L, et al. Conditional probability of long-term survival after liver resection for intrahepatic cholangiocarcinoma: a multiinstitutional analysis of 535 patients. JAMA Surg 2015;150:538–545.CrossRefPubMed Spolverato G, Kim Y, Ejaz A, Alexandrescu S, Marques H, Aldrighetti L, et al. Conditional probability of long-term survival after liver resection for intrahepatic cholangiocarcinoma: a multiinstitutional analysis of 535 patients. JAMA Surg 2015;150:538–545.CrossRefPubMed
8.
go back to reference Ribero D, Pinna AD, Guglielmi A, Ponti A, Nuzzo G, et al. Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients. Arch Surg 2012;147(12):1107–13.CrossRefPubMed Ribero D, Pinna AD, Guglielmi A, Ponti A, Nuzzo G, et al. Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients. Arch Surg 2012;147(12):1107–13.CrossRefPubMed
9.
go back to reference Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg 2014;149:565–574.CrossRefPubMed Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg 2014;149:565–574.CrossRefPubMed
10.
go back to reference Sakamoto Y, Kokudo N, Matsuyama Y, et al. Proposal of a new staging system for intrahepatic cholangiocarcinoma: Analysis of surgical patients from a nationwide survey of the Liver Cancer Study Group of Japan. Cancer 2016;122:61–70.CrossRefPubMed Sakamoto Y, Kokudo N, Matsuyama Y, et al. Proposal of a new staging system for intrahepatic cholangiocarcinoma: Analysis of surgical patients from a nationwide survey of the Liver Cancer Study Group of Japan. Cancer 2016;122:61–70.CrossRefPubMed
11.
go back to reference Sapisochin G, Facciuto M, Rubbia-Brandt L, et al. Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment. Hepatology 2016;64:1178–88.CrossRefPubMed Sapisochin G, Facciuto M, Rubbia-Brandt L, et al. Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment. Hepatology 2016;64:1178–88.CrossRefPubMed
12.
go back to reference Adachi T, Eguchi S. Lymph node dissection for intrahepatic cholangiocarcinoma: a critical review of the literature to date. J Hepatobiliary Pancreat Sci 2014;21:162–8.CrossRefPubMed Adachi T, Eguchi S. Lymph node dissection for intrahepatic cholangiocarcinoma: a critical review of the literature to date. J Hepatobiliary Pancreat Sci 2014;21:162–8.CrossRefPubMed
13.
go back to reference Jutric Z, Johnston WC, Hoen HM, et al. Impact of lymph node status in patients with intrahepatic cholangiocarcinoma treated by major hepatectomy: a review of the National Cancer Database. HPB 2016;18(1):79–87.CrossRefPubMedPubMedCentral Jutric Z, Johnston WC, Hoen HM, et al. Impact of lymph node status in patients with intrahepatic cholangiocarcinoma treated by major hepatectomy: a review of the National Cancer Database. HPB 2016;18(1):79–87.CrossRefPubMedPubMedCentral
14.
go back to reference Bagante F, Gani F, Spolverato G, et al.: Intrahepatic cholangiocarcinoma: Prognosis of patients who did not undergo lymphadenectomy. J Am Coll Surg 2015;221:1031–1040.CrossRefPubMed Bagante F, Gani F, Spolverato G, et al.: Intrahepatic cholangiocarcinoma: Prognosis of patients who did not undergo lymphadenectomy. J Am Coll Surg 2015;221:1031–1040.CrossRefPubMed
15.
go back to reference Guglielmi A, Ruzzenente A, Campagnaro T, et al. Patterns and prognostic significance of lymph node dissection for surgical treatment of perihilar and intrahepatic cholangiocarcinoma. J Gastrointest Surg 2013;17(11):1917–28.CrossRefPubMed Guglielmi A, Ruzzenente A, Campagnaro T, et al. Patterns and prognostic significance of lymph node dissection for surgical treatment of perihilar and intrahepatic cholangiocarcinoma. J Gastrointest Surg 2013;17(11):1917–28.CrossRefPubMed
16.
go back to reference Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Sueda T. Intrahepatic cholangiocarcinoma: clinicopathological differences between peripheral type and hilar type. J Gastrointest Surg 2012;16:540–8CrossRefPubMed Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Sueda T. Intrahepatic cholangiocarcinoma: clinicopathological differences between peripheral type and hilar type. J Gastrointest Surg 2012;16:540–8CrossRefPubMed
17.
go back to reference Shirabe K, Mano Y, Taketomi A, Soejima Y, Uchiyama H, Aishima S. Clinicopathological prognostic factors after hepatectomy for patients with mass-forming type intrahepatic cholangiocarcinoma: relevance of the lymphatic invasion index. Ann Surg Oncol 2010;17:1816–22CrossRefPubMed Shirabe K, Mano Y, Taketomi A, Soejima Y, Uchiyama H, Aishima S. Clinicopathological prognostic factors after hepatectomy for patients with mass-forming type intrahepatic cholangiocarcinoma: relevance of the lymphatic invasion index. Ann Surg Oncol 2010;17:1816–22CrossRefPubMed
18.
go back to reference Hyder O, Marques H, Pulitano C, Marsh JW, Alexandrescu S, Bauer TW et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg 2014;149:432–438.CrossRefPubMed Hyder O, Marques H, Pulitano C, Marsh JW, Alexandrescu S, Bauer TW et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg 2014;149:432–438.CrossRefPubMed
19.
go back to reference Zhang XF, Chakedis J, Bagante F, Chen Q, Beal EV, Lv Y, et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg 2018;105(7):857–866.CrossRefPubMed Zhang XF, Chakedis J, Bagante F, Chen Q, Beal EV, Lv Y, et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg 2018;105(7):857–866.CrossRefPubMed
20.
go back to reference Amini N., Ejaz A., Spolverato G., Maithel S.K., Kim Y., Pawlik T.M. Management of lymph nodes during resection of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: a systematic review. J Gastrointest Surg 2014;18:2136–2148.CrossRefPubMed Amini N., Ejaz A., Spolverato G., Maithel S.K., Kim Y., Pawlik T.M. Management of lymph nodes during resection of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: a systematic review. J Gastrointest Surg 2014;18:2136–2148.CrossRefPubMed
21.
go back to reference Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H et al. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg 2005;29(6):728–33.CrossRefPubMed Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H et al. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg 2005;29(6):728–33.CrossRefPubMed
22.
go back to reference Dhanasekaran R, Hemming AW, Zendejas I, George T, Nelson DR, Soldevila-Pico C, et al. Treatment outcomes and prognostic factors of intra-hepatic cholangiocarcinoma. Oncol Rep 2013;29:1259–1267.CrossRefPubMedPubMedCentral Dhanasekaran R, Hemming AW, Zendejas I, George T, Nelson DR, Soldevila-Pico C, et al. Treatment outcomes and prognostic factors of intra-hepatic cholangiocarcinoma. Oncol Rep 2013;29:1259–1267.CrossRefPubMedPubMedCentral
23.
go back to reference Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, Cappellani A, Malfermoni G, Iacono C. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 2009;33(6):1247–54.CrossRefPubMed Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, Cappellani A, Malfermoni G, Iacono C. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 2009;33(6):1247–54.CrossRefPubMed
24.
go back to reference Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol 2013;31(9):1188–1195CrossRefPubMed Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol 2013;31(9):1188–1195CrossRefPubMed
Metadata
Title
Role of Lymph Node Dissection in Small (≤ 3 cm) Intrahepatic Cholangiocarcinoma
Authors
Andrea Ruzzenente
Simone Conci
Luca Viganò
Giorgio Ercolani
Serena Manfreda
Fabio Bagante
Andrea Ciangherotti
Corrado Pedrazzani
Antonio D. Pinna
Calogero Iacono
Guido Torzilli
Alfredo Guglielmi
Publication date
01-06-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04108-0

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