Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma

Abstract

Lymph node metastases were seldom limited to the regional lymph nodes; most tumour recurrence occurred in the liver. Lymph node dissection did not appear to improve patient survival. Lymph node dissection alone is not likely to improve the prognosis without further control of liver metastases.

Surgical management of recurrent intrahepatic cholangiocarcinoma: predictors, adjuvant chemotherapy, and surgical therapy for recurrence: A multi‐institutional study by the Kyushu Study Group of Liver Surgery

“…In our 81 patients with lymph node recurrence, regional lymph node recurrence occurred in 13 patients only (16%). Therefore, we propose that aggressive and routine lymph node dissection in patients with ICC cannot always contribute to prevention of lymph node recurrence after operation 15, 16…”

“…Details of our surgical techniques and patient follow‐up methods have been reported previously 15, 16, 17. Major hepatectomies with bile duct resection were carried out when bile duct invasion of ICC was suspected to affect the first branch of the hepatic duct.…”

“…When surgeons believed it would be better to confirm the surgical margins, the resected stump was used for frozen pathology 15. The right and left lobes of the liver have different routes of lymphatic drainage, and thus the style of lymph node dissection was different according to tumor location on the right or left lobe 16. We generally did not carry out regional lymph node dissection in patients with peripheral ICC without macroscopic swelling lymph nodes.…”

Impact of adjuvant chemoradiation on survival in patients with resectable cholangiocarcinoma

“…Analogous to gallbladder and pancreatic adenocarcinomas, patients are often diagnosed late in the disease process with both nodal and distant metastases occurring early and often. [1][2][3][4][5][6][7][8] Among the minority of patients whose presentation is amenable to curative resection, local recurrence is the rule not the exception. 1,[9][10][11] While the only curative treatment for CC patients remains surgical resection, post-operative outcomes have shown no significant improvements in the past several years 11 with the current five-year survival rate stagnating at a mere 5% for all CC patients.…”

Effect of Adjuvant Gemcitabine Combined with Low-dose 5-Fluorouracil and Cisplatin Chemotherapy for Advanced Biliary Carcinoma

“…Many surgeons have advocated aggressive surgery, including major hepatectomy, extended lymph node (LN) dissection and combined vascular resection for improving surgical outcomes (2-8). However, despite aggressive liver surgery, the prognosis after surgery remains unsatisfactory, with 5-year survival rates of 19-35% for HC (5-8), 32-53% for GBC (9-11) and 23-29% for IHCC (12)(13)(14). Moreover, several investigators have indicated that LN metastasis, intrahepatic metastasis and positive surgical margins in the bile duct are poor prognostic factors (12-15).…”