Intrahepatic cholangiocarcinoma surgery: the impact of lymphadenectomy

Abstract

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignant tumor and its incidence is increasing over the world. At present times, radical liver resection is still the most effective treatment for ICC patients to achieve long term survival. Pathological lymph node metastases (LMN), found in 15% to 45% of the patients, have been recognized as an extremely poor prognostic risk factor, even if curative resection is performed. So, considering this issue, it acquires relevance to determine the validity of surgical resection for LNM cases that are diagnosed in the preoperative setting, or whether a routine lymphadenectomy should be performed systematically in all hepatectomies for ICC. The role of routine lymphadenectomy in the surgical treatment of ICC remains controversial, with some centers considering it standard whereas other surgeons perform lymphadenectomy only as a selective indication. Recently, a growing widespread adoption of lymphadenectomy was demonstrated that nearly doubled its commonly reported execution rate. The newly updated eight edition of the American Joint Committee on Cancer (AJCC) staging system now recommends that six nodes need to be analyzed to stage patients with ICC. In this review, we analyzed and summarized some anatomic considerations of the lymphatic anatomy of the liver and the current knowledge and potential advantages of performing a routine lymphadenectomy in patients with ICC, especially looking at pathological staging, prognosis, prevention of local recurrence and outcome. New areas like lymphadenectomy in cirrhotic patients and laparoscopic lymphadenectomy are also discussed.

Cholangiocarcinoma: anatomical location-dependent clinical, prognostic, and genetic disparities

“…Treatment of CCA depends on the anatomical location, but there are some surgical concerns remain further verification, including the use of lymph node dissection, liver transplantation, adjuvant chemotherapy, and target therapies (17)(18)(19)(20). In most surgery centers, lymph node metastasis is considered a contraindication for surgical options, but it is considered resectable when it is limited to be regional in partial hospitals (21,22).…”

The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

“…In cases that do proceed to resection, management of regional nodal disease is via regional lymphadenectomy, performed at the time of index operation. Lymph node (LN) metastases are found in as many as 15–45% of patients, in all stages of disease, and correlate with poor oncologic outcomes [ 27 , 72 , 73 , 74 ]. For those eligible for primary tumor resection, regional lymphadenectomy has been shown to impart some survival benefit [ 72 ].…”

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

“…Although the role of lymph node metastases as a poor prognostic factor with concomitant high disease recurrence rates is undisputed, the benefit of simultaneous lymphadenectomy in patients with ICC has been a matter of great debate since the latest AJCC/UICC edition recommended harvesting at least six lymph nodes along the portal vein for proper staging [38][39][40][41][42]. In our patient series, we observed a slight increase of lymphadenectomies over the last three decades resulting in an overall lymph node dissection rate of 63%.…”