The impact of tumor location on the value of lymphadenectomy for intrahepatic cholangiocarcinoma

Yutaka Endo, Zorays Moazzam, Henrique A. Lima, Laura Alaimo, Muhammad M. Munir, Chanza F. Shaikh, Alfredo Guglielmi, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Minoru Kitago, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas G. KoerkampItaru Endo, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background: The therapeutic role of lymphadenectomy (LND) for intrahepatic cholangiocarcinoma (ICC) patients remains ill-defined. We sought to analyze the therapeutic value of LND relative to tumor location and preoperative lymph node metastasis (LNM) risk. Methods: Patients who underwent curative-intent hepatic resection of ICC between 1990 and 2020 were included from a multi-institutional database. Therapeutic LND (tLND) was defined as LND that harvested ≥3 lymph nodes. Results: Among 662 patients, 178 (26.9%) individuals received tLND. Patients were categorized into central type ICC (n = 156, 23.6%) and peripheral type ICC (n = 506, 76.4%). Central type harbored multiple adverse clinicopathologic factors and worse overall survival (OS) compared with peripheral type (5-year OS, central: 27.0% vs. peripheral: 47.2%, p < 0.001). After consideration of preoperative LNM risk, patients with central type and high-risk LNM who underwent tLND survived longer than individuals who did not (5-year OS, tLND: 27.9% vs. non-tLND: 9.0%, p = 0.001), whereas tLND was not associated with better survival among patients with peripheral type ICC or low-risk LNM. The therapeutic index of hepatoduodenal ligament (HDL) and other regions was higher in central type than in peripheral type, which was more pronounced among high-risk LNM patients. Conclusions: Central type ICC with high-risk LNM should undergo LND involving regions beyond the HDL.

Original languageEnglish
Pages (from-to)650-658
Number of pages9
JournalHPB
Volume25
Issue number6
DOIs
Publication statusPublished - 2023 Jun

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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