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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2012

Open Access 01-12-2012 | Research

Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer

Authors: Takehiro Noji, Masaki Miyamoto, Kanako C Kubota, Toshiya Shinohara, Yoshiyasu Ambo, Yoshihiro Matsuno, Nobuichi Kashimura, Satoshi Hirano

Published in: World Journal of Surgical Oncology | Issue 1/2012

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Abstract

Background

Lymph node metastasis is one of the most important prognostic factors for extra-hepatic bile duct carcinoma (ExHBDC). Extra capsular lymph node involvement (ExCLNI) is the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The prognostic impact of ExCLNI has been shown to be significant mainly in head and neck malignancies. Recently, the prognostic impacts of ExCLNI have evaluated in gastrointestinal malignancies. However no data is available regarding the incidence and prognostic significance of extra-capsular lymph node involvement (ExCLNI) in resectable ExHBDCs. The aim of the present study is first to evaluate the incidence of ExCLNI in surgically-treated ExHBDCs and second, to determine the prognostic impact of ExCLNI in patients with surgically-treated ExHBDCs.

Methods

A total of 228 patients (110 cases of hilar cholangiocarcinoma and 118 cases of distal cholangiocarcinoma) with surgically-treated ExHBDCs were included in this retrospective study. ExCLNI was defined as the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The existence of ExCLNI and its prognostic value were analyzed as a subgroup of lymph node metastasis.

Results

ExCLNI was detected in only 22% of patients with lymph node metastasis of surgically-treated ExHBDC. The presence of ExCLNI correlated with distal cholangiocarcinoma (p = 0.002). On univariate analysis for survival, perineural invasion, vascular invasion, histological grade, and lymph node metastasis were statistically significant factors. On multivariate analysis, only lymph node metastasis was identified as a significant independent prognostic factor in patients with resectable ExHBDC. Subgroups of lymph node metastasis including the presence of ExCLNI, location of lymph node metastasis, and the number of lymph node metastasis had no statistically significant impact on survival.

Conclusion

ExCLNI was present in only 22% of the LNM (7% of overall patients) in patients with surgical treated ExHBDCs. And ExCLNI would have no impact on the survival of patients with surgically-treated ExHBDCs.
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Literature
1.
Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, Katoh H: Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004, 240: 95-101. 10.1097/01.sla.0000129491.43855.6b.PubMedCentralCrossRefPubMed
2.
Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N: Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepato-Biliary-Pan. 2000, 7: 155-162. 10.1007/s005340050170.CrossRef
3.
Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R: Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999, 230: 808-818. 10.1097/00000658-199912000-00010. discussion 819PubMedCentralCrossRefPubMed
4.
Hidalgo E, Asthana S, Nishio H, Wyatt J, Toogood GJ, Prasad KR, Lodge JP: Surgery for hilar cholangiocarcinoma: the Leeds experience. Eur J Surg Oncol. 2008, 34: 787-794. 10.1016/j.ejso.2007.10.005.CrossRefPubMed
5.
Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M: Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999, 230: 663-671. 10.1097/00000658-199911000-00008.PubMedCentralCrossRefPubMed
6.
Ito K, Ito H, Allen PJ, Gonen M, Klimstra D, D’Angelica MI, Fong Y, DeMatteo RP, Brennan MF, Blumgart LH, Jarnagin WR: Adequate lymph node assessment for extrahepatic bile duct adenocarcinoma. Ann Surg. 2010, 251: 675-681. 10.1097/SLA.0b013e3181d3d2b2.CrossRefPubMed
7.
Choi SB, Park SW, Kim KS, Choi JS, Lee WJ: The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection. J Surg Oncol. 2009, 99: 335-342. 10.1002/jso.21238.CrossRefPubMed
8.
Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S: Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003, 238: 84-92.PubMedCentralPubMed
9.
Miyakawa S, Ishihara S, Horiguchi A, Takada T, Miyazaki M, Nagakawa T: Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan. J Hepato-Biliary-Pan. 2009, 16: 1-7. 10.1007/s00534-008-0015-0.CrossRef
10.
Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, Yoshitomi H, Furukawa K, Takeuchi D, Takayashiki T: One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. J Hepatobiliary Pancreat Surg. 2009
11.
Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, Makuuchi M: Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003, 238: 73-83.PubMedCentralPubMed
12.
Yonemori A, Kondo S, Matsuno Y, Ito T, Nakanishi Y, Miyamoto M, Tanaka E, Hirano S: Prognostic impact of regional lymph node micrometastasis in patients with node-negative biliary cancer. Ann Surg. 2010, 252: 99-106. 10.1097/SLA.0b013e3181e33c0a.CrossRefPubMed
13.
Yonemori A, Kondo S, Matsuno Y, Ito T, Tanaka E, Hirano S: Prognostic impact of para-aortic lymph node micrometastasis in patients with regional node-positive biliary cancer. Br J Surg. 2009, 96: 509-516. 10.1002/bjs.6585.CrossRefPubMed
14.
Yoshida T, Matsumoto T, Sasaki A, Morii Y, Aramaki M, Kitano S: Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer. Arch Surg. 2002, 137: 69-73. 10.1001/archsurg.137.1.69.CrossRefPubMed
15.
Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T: Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg. 2007, 31: 337-342. 10.1007/s00268-006-0224-0. discussion 343–334CrossRefPubMed
16.
Kawai M, Tani M, Kobayashi Y, Tsuji T, Tabuse K, Horiuchi T, Oka M, Yamaguchi K, Sakata Y, Shimomura T, Yamaue H: The ratio between metastatic and examined lymph nodes is an independent prognostic factor for patients with resectable middle and distal bile duct carcinoma. Am J Surg. 2010, 199: 447-452. 10.1016/j.amjsurg.2009.01.019.CrossRefPubMed
17.
Alakus H, Holscher AH, Grass G, Hartmann E, Schulte C, Drebber U, Baldus SE, Bollschweiler E, Metzger R, Monig SP: Extracapsular lymph node spread: a new prognostic factor in gastric cancer. Cancer. 2010, 116: 309-315. 10.1002/cncr.24764.CrossRefPubMed
18.
Metzger R, Drebber U, Baldus SE, Monig SP, Holscher AH, Bollschweiler E: Extracapsular lymph node involvement differs between squamous cell and adenocarcinoma of the esophagus. Ann Surg Oncol. 2009, 16: 447-453. 10.1245/s10434-008-0248-9.CrossRefPubMed
19.
Okamoto T, Tsuburaya A, Kameda Y, Yoshikawa T, Cho H, Tsuchida K, Hasegawa S, Noguchi Y: Prognostic value of extracapsular invasion and fibrotic focus in single lymph node metastasis of gastric cancer. Gastric Cancer. 2008, 11: 160-167. 10.1007/s10120-008-0473-8.CrossRefPubMed
20.
Wind J, ten Kate FJ, Kiewiet JJ, Lagarde SM, Slors JF, van Lanschot JJ, Bemelman WA: The prognostic significance of extracapsular lymph node involvement in node positive patients with colonic cancer. Eur J Surg Oncol. 2008, 34: 390-396. 10.1016/j.ejso.2007.05.011.CrossRefPubMed
21.
van der Gaag NA, ten Kate FJ, Lagarde SM, Busch OR, van Gulik TM, Gouma DJ: Prognostic significance of extracapsular lymph node involvement in patients with adenocarcinoma of the ampulla of Vater. Br J Surg. 2008, 95: 735-743. 10.1002/bjs.6076.CrossRefPubMed
22.
Sergeant G, Ectors N, Fieuws S, Aerts R, Topal B: Prognostic relevance of extracapsular lymph node involvement in pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2009, 16: 3070-3079. 10.1245/s10434-009-0627-x.CrossRefPubMed
23.
Wind J, Lagarde SM, Ten Kate FJ, Ubbink DT, Bemelman WA, van Lanschot JJ: A systematic review on the significance of extracapsular lymph node involvement in gastrointestinal malignancies. Eur J Surg Oncol. 2007, 33: 401-408. 10.1016/j.ejso.2006.11.001.CrossRefPubMed
24.
Stitzenberg KB, Meyer AA, Stern SL, Cance WG, Calvo BF, Klauber-DeMore N, Kim HJ, Sansbury L, Ollila DW: Extracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burden. Ann Surg. 2003, 237: 607-612. discussion 612–603PubMedCentralPubMed
25.
Rice TW, Blackstone EH, Rusch VW: 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010, 17: 1721-1724. 10.1245/s10434-010-1024-1.CrossRefPubMed
26.
Surgery JSoB: The general rules for surgical and pathological studies on cancer of the biliary tract, 2nd edition. 2004, Tokyo: Kanehara, 2
27.
Noji T, Kondo S, Hirano S, Tanaka E, Suzuki O, Shichinohe T: Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer. Br J Surg. 2008, 95: 92-96.CrossRefPubMed
28.
Noji T, Kondo S, Hirano S, Tanaka E, Ambo Y, Kawarada Y, Morikawa T: CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer. J Gastroenterol. 2005, 40: 739-743. 10.1007/s00535-005-1618-8.CrossRefPubMed
29.
Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, Matsumoto J, Kawasaki R: Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepato-Biliary-Pan. 2009, 17: 455-462.CrossRef
30.
Nakanishi Y, Kondo S, Zen Y, Yonemori A, Kubota K, Kawakami H, Tanaka E, Hirano S, Itoh T, Nakanuma Y: Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci. 2010, 17: 166-173. 10.1007/s00534-009-0127-1.CrossRefPubMed
31.
Imre K, Pinar E, Oncel S, Calli C, Tatar B: Predictors of extracapsular spread in lymph node metastasis. Eur Arch Oto-Rhino-L. 2008, 265: 337-339. 10.1007/s00405-007-0464-0.CrossRef
32.
Nakamura K, Ozaki N, Yamada T, Hata T, Sugimoto S, Hikino H, Kanazawa A, Tokuka A, Nagaoka S: Evaluation of prognostic significance in extracapsular spread of lymph node metastasis in patients with gastric cancer. Surgery. 2005, 137: 511-517. 10.1016/j.surg.2005.01.007.CrossRefPubMed
33.
Di Giorgio A, Botti C, Sammartino P, Mingazzini P, Flammia M, Stipa V: Extracapsular lymphnode metastases in the staging and prognosis of gastric cancer. Int Surg. 1991, 76: 218-221.PubMed
34.
Lagarde SM, ten Kate FJ, de Boer DJ, Busch OR, Obertop H, van Lanschot JJ: Extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal esophagus or gastroesophageal junction. Am J Surg Pathol. 2006, 30: 171-176. 10.1097/01.pas.0000189182.92815.12.CrossRefPubMed
35.
Fleischmann A, Thalmann GN, Markwalder R, Studer UE: Prognostic implications of extracapsular extension of pelvic lymph node metastases in urothelial carcinoma of the bladder. Am J Surg Pathol. 2005, 29: 89-95. 10.1097/01.pas.0000147396.08853.26.CrossRefPubMed
36.
Greenberg JS, Fowler R, Gomez J, Mo V, Roberts D, El Naggar AK, Myers JN: Extent of extracapsular spread: a critical prognosticator in oral tongue cancer. Cancer. 2003, 97: 1464-1470. 10.1002/cncr.11202.CrossRefPubMed
Metadata
Title
Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer
Authors
Takehiro Noji
Masaki Miyamoto
Kanako C Kubota
Toshiya Shinohara
Yoshiyasu Ambo
Yoshihiro Matsuno
Nobuichi Kashimura
Satoshi Hirano
Publication date
01-12-2012
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2012
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-10-106

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