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Journal of Gastrointestinal Surgery

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01-03-2019 | Original Article

Oncologic Impact of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma: a Propensity Score-Matched Study

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

Published in: Journal of Gastrointestinal Surgery | Issue 3/2019

Abstract

Background

Intrahepatic cholangiocarcinoma is a malignancy of the intrahepatic biliary tree. Although surgical resection is the mainstay of treatment for this tumor, the impact of lymph node dissection during hepatectomy is controversial. In this study, we evaluated the impact of lymph node dissection during surgical resection for intrahepatic cholangiocarcinoma.

Methods

Records from 170 patients who underwent radical hepatectomy for intrahepatic cholangiocarcinoma from January 2000 to December 2014 were retrospectively reviewed. Twenty-two patients who underwent R1 resection or had distant metastasis at the time of surgery were excluded. Using propensity score matching (matched factors: differentiation, lymphovascular invasion, perineural invasion, and T stage), the patients were divided into two groups: no dissection (n = 34) or lymph node dissection (n = 34). Disease-free survival and overall survival were compared between groups.

Results

There was a marginally significant difference between the two groups with respect to the disease-free survival (no dissection vs. lymph node dissection: 20.0 [4.2–35.8] months vs. 64.0 [27.3–120.8] months, p = 0.077). Overall survival was significantly longer in the lymph node dissection group (no dissection vs. lymph node dissection: 44.0 [31.1–56.9] months vs. 90.0 [51.1–158.9] months, p = 0.027).

Conclusion

Radical surgery including an adequate lymph node dissection area and suitable harvested lymph nodes appears to improve oncologic outcomes for intrahepatic cholangiocarcinoma.

Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Annals of surgery. 1996;224(4):463–73; discussion 73-5.CrossRefPubMedPubMedCentral

Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg. 2009;208(1):134–47. doi:https://doi.org/10.1016/j.jamcollsurg.2008.09.007.CrossRefPubMed

Njei B. Changing pattern of epidemiology in intrahepatic cholangiocarcinoma. Hepatology. 2014;60(3):1107–8. doi:https://doi.org/10.1002/hep.26958.CrossRefPubMed

Saha SK, Zhu AX, Fuchs CS, Brooks GA. Forty-Year Trends in Cholangiocarcinoma Incidence in the U.S.: Intrahepatic Disease on the Rise. Oncologist. 2016;21(5):594–9. doi:https://doi.org/10.1634/theoncologist.2015-0446.CrossRefPubMedPubMedCentral

Bridgewater J, Galle PR, Khan SA, Llovet JM, Park JW, Patel T et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. Journal of hepatology. 2014;60(6):1268–89. doi:https://doi.org/10.1016/j.jhep.2014.01.021.CrossRefPubMed

Weber SM, Jarnagin WR, Klimstra D, DeMatteo RP, Fong Y, Blumgart LH. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg. 2001;193(4):384–91.CrossRefPubMed

Endo I, Gonen M, Yopp AC, Dalal KM, Zhou Q, Klimstra D et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Annals of surgery. 2008;248(1):84–96. doi:https://doi.org/10.1097/SLA.0b013e318176c4d3.CrossRefPubMed

Si A, Li J, Xiang H, Zhang S, Bai S, Yang P et al. Actual over 10-year survival after liver resection for patients with intrahepatic cholangiocarcinoma. Oncotarget. 2017;8(27):44521–32. doi:https://doi.org/10.18632/oncotarget.17815.CrossRefPubMedPubMedCentral

Shirabe K, Shimada M, Harimoto N, Sugimachi K, Yamashita Y, Tsujita E et al. Intrahepatic cholangiocarcinoma: its mode of spreading and therapeutic modalities. Surgery. 2002;131(1 Suppl):S159–64.CrossRefPubMed

10.

Adachi T, Eguchi S. Lymph node dissection for intrahepatic cholangiocarcinoma: a critical review of the literature to date. Journal of hepato-biliary-pancreatic sciences. 2014;21(3):162–8. doi:https://doi.org/10.1002/jhbp.30.CrossRefPubMed

11.

Weber SM, Ribero D, O’Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015;17(8):669–80. doi:https://doi.org/10.1111/hpb.12441.CrossRefPubMedPubMedCentral

12.

Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK et al. AJCC Cancer Staging Manual, 8 ed. New York: Springer International Publishing, 2017, pp 295-301.

13.

Spolverato G, Bagante F, Weiss M, Alexandrescu S, Marques HP, Aldrighetti L et al. Comparative performances of the 7th and the 8th editions of the American Joint Committee on Cancer staging systems for intrahepatic cholangiocarcinoma. J Surg Oncol. 2017;115(6):696–703. doi:https://doi.org/10.1002/jso.24569.CrossRefPubMed

14.

Choi SB, Kim KS, Choi JY, Park SW, Choi JS, Lee WJ et al. The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol. 2009;16(11):3048–56. doi:https://doi.org/10.1245/s10434-009-0631-1.CrossRefPubMed

15.

Rizvi S, Khan SA, Hallemeier CL, Kelley RK, Gores GJ. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Nat Rev Clin Oncol 2018;15(2):95–111.

16.

Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33(6):1247–54. doi:https://doi.org/10.1007/s00268-009-9970-0.CrossRefPubMed

17.

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 surgery. 2014;149(5):432–8. doi:https://doi.org/10.1001/jamasurg.2013.5168.CrossRefPubMed

18.

Luo X, Yuan L, Wang Y, Ge R, Sun Y, Wei G. Survival outcomes and prognostic factors of surgical therapy for all potentially resectable intrahepatic cholangiocarcinoma: a large single-center cohort study. J Gastrointest Surg 2014;18(3):562–72. doi:https://doi.org/10.1007/s11605-013-2447-3.CrossRefPubMed

19.

Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and Prognosis for Patients With Intrahepatic Cholangiocarcinoma: Systematic Review and Meta-analysis. JAMA Surgery. 2014;149(6):565–74. doi:https://doi.org/10.1001/jamasurg.2013.5137.CrossRefPubMed

20.

Tang H, Lu W, Li B, Meng X, Dong J. Influence of surgical margins on overall survival after resection of intrahepatic cholangiocarcinoma: A meta-analysis. Medicine. 2016;95(35):e4621. doi:https://doi.org/10.1097/md.0000000000004621.CrossRefPubMedPubMedCentral

21.

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. doi:https://doi.org/10.1007/s00268-005-7761-9.CrossRefPubMed

22.

Uchiyama K, Yamamoto M, Yamaue H, Ariizumi S, Aoki T, Kokudo N et al. Impact of nodal involvement on surgical outcomes of intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Journal of hepato-biliary-pancreatic sciences. 2011;18(3):443–52. doi:https://doi.org/10.1007/s00534-010-0349-2.CrossRefPubMed

23.

Wang K, Zhang H, Xia Y, Liu J, Shen F. Surgical options for intrahepatic cholangiocarcinoma. Hepatobiliary surgery and nutrition. 2017;6(2):79–90. doi:https://doi.org/10.21037/hbsn.2017.01.06.CrossRefPubMedPubMedCentral

24.

Li DY, Zhang HB, Yang N, Quan Y, Yang GS. Routine lymph node dissection may be not suitable for all intrahepatic cholangiocarcinoma patients: results of a monocentric series. World J Gastroenterol. 2013;19(47):9084–91. doi:https://doi.org/10.3748/wjg.v19.i47.9084.CrossRefPubMedPubMedCentral

25.

Shimada K, Sano T, Nara S, Esaki M, Sakamoto Y, Kosuge T et al. Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery. 2009;145(4):411–6. doi:https://doi.org/10.1016/j.surg.2008.11.010.CrossRefPubMed

26.

Yamamoto M, Takasaki K, Yoshikawa T. Lymph node metastasis in intrahepatic cholangiocarcinoma. Jpn J Clin Oncol. 1999;29(3):147–50.CrossRefPubMed

27.

Kim DH, Choi DW, Choi SH, Heo JS, Kow AW. Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution. Surgery. 2015;157(4):666–75. doi:https://doi.org/10.1016/j.surg.2014.11.006.CrossRefPubMed

28.

Bagante F, Gani F, Spolverato G, Xu L, Alexandrescu S, Marques HP et al. Intrahepatic Cholangiocarcinoma: Prognosis of Patients Who Did Not Undergo Lymphadenectomy. J Am Coll Surg. 2015;221(6):1031–40.e1–4. doi:https://doi.org/10.1016/j.jamcollsurg.2015.09.012.CrossRef

29.

de Jong MC, Nathan H, Sotiropoulos GC, 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(23):3140–5. doi:https://doi.org/10.1200/jco.2011.35.6519.CrossRefPubMed

30.

Jutric Z, Johnston WC, Hoen HM, Newell PH, Cassera MA, Hammill CW et al. Impact of lymph node status in patients with intrahepatic cholangiocarcinoma treated by major hepatectomy: a review of the National Cancer Database. HPB (Oxford). 2016;18(1):79–87. doi:https://doi.org/10.1016/j.hpb.2015.07.006.CrossRefPubMedPubMedCentral

31.

Ribero D, Pinna AD, Guglielmi A, Ponti A, Nuzzo G, Giulini SM 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. doi:https://doi.org/10.1001/archsurg.2012.1962.CrossRefPubMed

32.

Vitale A, Moustafa M, Spolverato G, Gani F, Cillo U, Pawlik TM. Defining the possible therapeutic benefit of lymphadenectomy among patients undergoing hepatic resection for intrahepatic cholangiocarcinoma. J Surg Oncol. 2016;113(6):685–91. doi:https://doi.org/10.1002/jso.24213.CrossRefPubMed

33.

Morine Y, Shimada M. The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics. Journal of gastroenterology. 2015;50(9):913–27. doi:https://doi.org/10.1007/s00535-015-1071-2.CrossRefPubMed

34.

Wada H, Hyun H, Vargas C, Genega EM, Gravier J, Gioux S et al. Sentinel Lymph Node Mapping of Liver. Ann Surg Oncol. 2015;22 Suppl 3:S1147–55. doi:https://doi.org/10.1245/s10434-015-4601-5.CrossRefPubMed

35.

Nozaki Y, Yamamoto M, Ikai I, Yamamoto Y, Ozaki N, Fujii H et al. Reconsideration of the lymph node metastasis pattern (N factor) from intrahepatic cholangiocarcinoma using the International Union Against Cancer TNM staging system for primary liver carcinoma. Cancer. 1998;83(9):1923–9.CrossRefPubMed

36.

Okami J, Dono K, Sakon M, Tsujie M, Hayashi N, Fujiwara Y et al. Patterns of regional lymph node involvement in intrahepatic cholangiocarcinoma of the left lobe. J Gastrointest Surg. 2003;7(7):850–6.CrossRefPubMed

37.

Brown KM, Parmar AD, Geller DA. Intrahepatic cholangiocarcinoma. Surgical oncology clinics of North America. 2014;23(2):231–46. doi:https://doi.org/10.1016/j.soc.2013.10.004.CrossRefPubMedPubMedCentral

38.

Adachi T, Eguchi S, Beppu T, Ueno S, Shiraishi M, Okuda K et al. Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery. Ann Surg Oncol. 2015;22(7):2269–78. doi:https://doi.org/10.1245/s10434-014-4239-8.CrossRefPubMed

Title: Oncologic Impact of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma: a Propensity Score-Matched Study
Authors: Sung Hyun Kim
Dai Hoon Han
Gi Hong Choi
Jin Sub Choi
Kyung Sik Kim
Publication date: 01-03-2019
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 3/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3899-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Oncologic Impact of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma: a Propensity Score-Matched Study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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