Comparison of the Sixth and the Seventh Editions of the UICC Classification for Perihilar Cholangiocarcinoma

Does the extent of lymphadenectomy, number of lymph nodes, positive lymph node ratio and neutrophil–lymphocyte ratio impact surgical outcome of perihilar cholangiocarcinoma?

“…They showed that the location of the involved nodes (regional or distant) had no impact on OS, whereas patients with multiple LN metastases in comparison with single LN metastasis had worse OS [risk ratio 1.61 (1.01-2.56)]. In view of this, they recommended that five LNs are a basic minimum for adequate LN assessment [1,35,36]. Interestingly, 29.4% of patients in this study had more than 15 LNs removed, in keeping with the latest guidelines, which in our study was 28% (22/78 patients).…”

“…Perihilar cholangiocarcinoma (PHCCA) accounts for 60% of all cholangiocarcinomas and is considered as a locoregional disease [1,2]. Radical surgery with lymphadenectomy is the only curative treatment option for PHCCA [3][4][5][6].…”

Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)

“…The AJCC/UICC 7 th Edition that incorporates the TNM staging system is simple and is the most widely used postoperatively, but it cannot allow evaluation of local resectability of the tumour and, therefore, does not help with the decision about the various surgical options. In comparison with the 6 th edition, the 7 th edition of the AJCC manual allows improved prediction of survival and stratification of prognostic classes of patients who have undergone resection 234 .…”

Comparison of Number Versus Ratio of Positive Lymph Nodes in the Assessment of Lymph Node Status in Extrahepatic Cholangiocarcinoma

“…Conversely, few 5-year survivors with nodal disease were reported in studies that evaluated a smaller number of lymph nodes. [27][28][29] Although it is possible to speculate that thorough regional lymphadenectomy has a potentially positive effect on survival, a more likely explanation for the aforementioned observations is inaccurate staging of patients with a smaller TLNC (stage migration) given the lack of evidence of any direct therapeutic effect of extensive lymphadenectomy in both our series and the literature. Resection of a larger number of lymph nodes than customary is warranted for accurate staging of nodal disease in extrahepatic cholangiocarcinoma.…”

“…The uniformly poor outcomes of node-positive patients with extrahepatic cholangiocarcinoma 27,28 have prompted some surgeons to consider the existence of nodal disease as the sole measure of nodal status rather than assess the extent of nodal disease. In 2010, Ito et al 29 stated that subdivision of nodal disease according to the number of positive nodes did not appear to be warranted for extrahepatic cholangiocarcinoma, but others have advocated subdivision of the number of positive nodes.…”