Lymphatic spreading pattern of intrahepatic cholangiocarcinoma

Tsuji, Tatsuya; Hiraoka, Tomoaki; Kanemitsu, Keiichirou; Takamori, Hisa; Tanabe, Dairo; Tashiro, Saki

doi:10.1016/s0039-6060(01)49159-8

Cited by 61 publications

(41 citation statements)

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“…LN status was included in the staging system of IHCC in the seventh edition TNM classification, and regional LNs were also defined in this system [62]. In addition, three major abdominal routes of lymphatic spread of IHCC, including the hepatoduodenal, cardiac, and diaphragmatic routes, have been reported [63]. Nevertheless, the definition of regional LNs of the liver has not been established.…”

Section: Ln Dissection In the Literaturementioning

confidence: 99%

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

Morine

Shimada

2015

J Gastroenterol

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Lymph node (LN) metastasis from intrahepatic cholangiocarcinoma (IHCC) might be one of the most important indicators of aggressive surgical resection, yet the value of LN dissection is still controversial. To address this clinical problem, we need to better understand the multidirectional lymphatic outflow from the liver. Although most hepatic lymph flows into the hilar LNs along portal triads, there are also several lymphatic outflows directly communicating with distant areas or the general lymphatic system. Moreover, it has been revealed that LN metastasis spreads to more distal LNs through the hepatoduodenal ligament or other multidirectional lymphatic pathways connected to the general lymphatic system. Therefore, systematic LN dissection might merely be LN sampling in IHCC with LN metastasis. A multidisciplinary strategy focusing on adjuvant treatment after surgery is immediately necessary in these cases. In IHCC without LN metastasis, the accuracy of preoperative imaging assessment of LN metastasis is unsatisfactory and useless for detecting metastatic LNs in clinical settings. Therefore, prophylactic systematic LN dissection for IHCC without preoperative LN swelling is recommended for accurate LN status assessment and reduction of local recurrences. However, this procedure might not offer any clinical benefit according to the results of retrospective comparative studies. In this review, we summarize previous reports regarding lymphatic outflow of the liver and discuss LN dissection for IHCC.

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Section: Ln Dissection In the Literaturementioning

confidence: 99%

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

Morine

Shimada

2015

J Gastroenterol

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“…Hepatoduodenal ligament is the most common site of nodal metastasis in ICC patients irrespective of the tumor location. Almost all patients are involved in positive lymph nodes of the hepatoduodenal ligament or along the common hepatic artery, lymph nodes are also found in about half of the patients involving the left lobe of liver [43,44,[53][54][55][56] . Nozaki et al [57] reported that extensive lymph node metastasis was observed in most patients, only 3 (20%) of 15 patients with lymph node metastasis had regional lymph node metastasis.…”

Section: Lymph Node Metastasismentioning

confidence: 99%

“…Their median survival time was 14.1 mo and none of them survived 5 years except for one patient with the IG type of ICC, suggesting that the presence of lymph node metastasis in the MF type of ICC is a sign of noncurability. However, a longer survival time (over 5 years) in ICC patients with lymph node metastasis has been described [54,58] . (3 …”

Section: Assessment Of Resectabilitymentioning

confidence: 99%

Current status of intrahepatic cholangiocarcinoma

Yang¹,

Yan²

2008

WJG

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Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver cancer with a global increasing trend in recent years. Symptoms tend to be vague and insidious in development, often are diagnosed at an advanced stage when only palliative approaches can be used with a median survival rate of months. Comparing with HCC, ICC tends to spread to lymph nodes early, and is rarely limited to the regional lymph nodes, with a frequent postoperative recurrence. Surgery is the only choice of curative therapy for ICC, but recently no consensus has been established for operation. Thus, more data from multiple centers and more cases are needed. Generally speaking, current adjunctive therapy cannot clearly improve survival. Further research is needed to find more effective radio-and chemotherapeutic regimens.

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“…After full text review, 23 articles were excluded, since they did not report the rate of lymph node stations separately. Therefore, 12 studies were finally included (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) The flowchart of the selection process is shown in Figure 1. Of the 12 studies, six were on intrahepatic bile duct tumours (584 patients), four on extrahepatic bile duct cancer (244 patients), and three on gallbladder cancer (247 patients) (one study was on both intraand extrahepatic tumours.…”

Section: Resultsmentioning

confidence: 99%