Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 21, 2013; 19(47): 9084-9091
Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.9084
Routine lymph node dissection may be not suitable for all intrahepatic cholangiocarcinoma patients: Results of a monocentric series
Dong-Yu Li, Hai-Bin Zhang, Ning Yang, Yuan Quan, Guang-Shun Yang
Dong-Yu Li, Hai-Bin Zhang, Ning Yang, Yuan Quan, Guang-Shun Yang, Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Author contributions: Li DY performed data collection and analysis and drafted the manuscript; Zhang HB and Yang N designed the study and edited the manuscript; Quan Y performed data collection and analysis; Yang GS designed the study, wrote and revised the manuscript.
Correspondence to: Guang-Shun Yang, Professor, Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai 200438, China. forlouiseluo@gmail.com
Telephone: +86-21-81875292 Fax: +86-21-81875292
Received: July 15, 2013
Revised: October 21, 2013
Accepted: November 2, 2013
Published online: December 21, 2013
Abstract

AIM: To investigate the indications for lymph node dissection (LND) in intrahepatic cholangiocarcinoma patients.

METHODS: A retrospective analysis was conducted on 124 intrahepatic cholangiocarcinoma (ICC) patients who had undergone surgical resection of ICC from January 2006 to December 2007. Curative resection was attempted for all patients unless there were metastases to lymph nodes (LNs) beyond the hepatoduodenal ligament. Prophylactic LND was performed in patients in whom any enlarged LNs had been suspicious for metastases. The patients were classified according to the LND and LN metastases. Clinicopathologic, operative, and long-term survival data were collected retrospectively. The impact on survival of LND during primary resection was analyzed.

RESULTS: Of 53 patients who had undergone hepatic resection with curative intent combined with regional LND, 11 had lymph nodes metastases. Whether or not patients without lymph node involvement had undergone LND made no significant difference to their survival (P = 0.822). Five patients with multiple tumors and involvement of lymph nodes underwent hepatic resection with LND; their survival curve did not differ significantly from that of the palliative resection group (P = 0.744). However, there were significant differences in survival between patients with lymph node involvement and a solitary tumor who underwent hepatic resection with LND and the palliative resection group (median survival time 12 mo vs 6.0 mo, P = 0.013).

CONCLUSION: ICC patients without lymph node involvement and patients with multiple tumors and lymph node metastases may not benefit from aggressive lymphadenectomy. Routine LND should be considered with discretion.

Keywords: Intrahepatic cholangiocarcinoma, Lymph node dissection, Lymph node metastases, Postoperative survival

Core tip: The indications for lymph node dissection (LND) in patients with intrahepatic cholangiocarcinoma (ICC) are still controversial. Our findings may provide a reference to the criterion for LND in ICC patients. Routine LND should be considered with discretion for ICC patients without lymph node involvement and patients with multiple tumors and lymph node metastases.