Is lymph node dissection necessary for resectable intrahepatic cholangiocarcinoma? A systematic review and meta-analysis

Zhou, Rui; Lu, Danbo; Li, Wenda; Tan, Wenliang; Zhu, Sicong; Chen, Xianqing; Jun, Min; Shang, Chao; Chen, Yajin

doi:10.1016/j.hpb.2018.12.011

Cited by 73 publications

(47 citation statements)

References 34 publications

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“…Previous studies have found that adjuvant TACE can improve ICC patient prognosis following resection, mainly by reducing the rate of recurrence. However, this has been questioned by Shen et al In our opinion, adjuvant TACE might reduce the risk of recurrence when cancerous cells are carried in the blood, but it is insufficient in cases where they are spread through the lymph system . In this study, we found that adjuvant TACE prolonged the median DFS but failed to prolong the median OS, which is consistent with our hypothesis.…”

Section: Discussionsupporting

confidence: 90%

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

et al. 2020

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Background and Aims: The prognosis of intrahepatic cholangiocarcinoma (ICC) after radical resection is far from satisfactory; however, the clinical value of adjuvant therapy (AT) remains controversial. This multicenter study aimed to evaluate the clinical value of AT and identify potential patients who would be benefited from AT. Methods: Data from ICC patients who underwent radical resection were retrospectively collected from 12 hepatobiliary centers in China between December 2012 and December 2015. Patients were divided into AT and non-AT groups based on whether AT was administered or not. Overall survival (OS) and disease-free survival (DFS)were analyzed using the Kaplan-Meier method before and after 1:2 propensity score matching (PSM). Subgroup analyses were conducted based on the established staging systems. | 2675WANG et Al.

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Section: Discussionsupporting

confidence: 90%

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

et al. 2020

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“…A systematic review and meta-analysis by Zhou et al concluded that lymphadenectomy does not improve disease-free or overall survival but instead increases postoperative morbidity. Furthermore, in the case of lymph node positivity, lymph node dissection results in worse survival [ 44 ]. Kizy et al even showed that surgical resection of lymph node positive ICC does not improve survival when compared with chemotherapy alone [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

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

Beetz

Weigle

Cammann

et al. 2020

Langenbecks Arch Surg

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Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

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“…In iCCA and pCCA, regional lymphadenectomy is considered a standard procedure in the course of liver resection due to its impact on the correct staging of the patient, rather than its effect on the improvement of long-term results, as recommended by different guidelines and consensus [16 , 34-37] . In a recent meta-analysis of 13 studies including 1377 patients, there were no significant differences in OS, disease-free survival, or recurrence between the lymph node dissection (LND) + group and the LND − group, but post-operative morbidity was significantly higher in the LND + group [42] . In a large recent surgical series, positive lymph nodes were found in up to 17% of resected patients [43] .…”

Section: Surgerymentioning

confidence: 99%

Italian Clinical Practice Guidelines on Cholangiocarcinoma – Part II: Treatment

Alvaro

Hassan

Cardinale

et al. 2020

Digestive and Liver Disease

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Is lymph node dissection necessary for resectable intrahepatic cholangiocarcinoma? A systematic review and meta-analysis

Cited by 73 publications

References 34 publications

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

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

Italian Clinical Practice Guidelines on Cholangiocarcinoma – Part II: Treatment

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