Prognostic value of lymphadenectomy for long-term outcomes in node-negative intrahepatic cholangiocarcinoma: A multicenter study

Yoh, Tomoaki; Cauchy, François; Roy, Bertrand Le; Seo, Satoru; Taura, Kojiro; Hobeika, Christian; Dokmak, Safi; Farges, O; Gelli, Maximiliano; Cunha, Antonio Sa; Adam, René; Üemoto, Shinji; Soubrane, Olivier

doi:10.1016/j.surg.2019.06.025

Cited by 52 publications

(54 citation statements)

References 33 publications

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“…They performed lymphadenectomy in one group and did not perform this procedure in the other group. The patients who underwent liver resection with lymphadenectomy achieved better 5-year overall survival rate (65% vs 46%, P = 0.017) and disease-free survival (34% vs 31%; P = 0.042) outcomes compared with patients who underwent liver resection without lymphadenectomy [14]. Furthermore, Kim et al reached the same conclusion in another propensity scorematched study [13].…”

Section: Discussionmentioning

confidence: 73%

“…The 5-year overall survival rate for patients with LNM is less than 20% [8]. In recent years, some studies have suggested that routine LND can improve the long-term survival of ICC patients [13,14], but other studies have concluded that LND should only be recommended for patients who are clinically diagnosed as LN-positive [6,15]. Thus, its clinical value is still questionable.…”

Section: Discussionmentioning

confidence: 99%

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The Clinical Value of Regional Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Results of A Retrospective Cohort Study

Yang

CHEN

et al. 2020

Preprint

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Objective: The aim of this study was to explore the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC). Methods: Clinical and pathological data were collected from 147 ICC patients who attended two tertiary centers over the past 5 years. The patients were classified into two groups: the LND group (group A) and the no-performance LND (NLND) group (group B). Clinical and pathological parameters were compared between the two groups to analyze the impact of LND on the prognosis of ICC patients. Results: Of the 147 patients, 54.4% (80) received LND and 42.5% (34/80) of these were found to have lymph node metastasis (LNM) in postoperative pathological diagnosis. Patients undergoing LND usually have a larger surgical range, including hemihepatectomy and enlarged hemihepatectomy (P = 0.001). LND did not increase postoperative complications (27.5%, P = 0.354), but postoperative hospital stays were longer (12.2 ± 6.3 d, P = 0.005) in group A compared with group B (20.9%, 9.5 ± 3.5 d). The 5-year survival rates of groups A and B are almost similar (21% vs 29%, P=0.905). The overall survival rate of cN0 (diagnosis obtained by imaging) is better than pN1 (diagnosis obtained by histopathology), but lower than pN0. (all P < 0.05). Elevated CA19-9 level (HR = 1.764, 95% CI: 1.113 ~ 2.795 , P = 0.016), vascular invasion (HR = 2.697, 95% CI: 1.103 ~ 6.599, P = 0.030), and T staging (HR = 1.848, 95% CI: 1.059 ~ 3.224, P = 0.031) were independent risk factors for poor ICC prognosis (all P values > 0.05).Conclusion: ICC patients with cN0 may have LNM, and the prognosis of LNM patients is usually poor. Our data may support routine lymphadenectomy for ICC.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

The Clinical Value of Regional Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Results of A Retrospective Cohort Study

Yang

CHEN

et al. 2020

Preprint

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“…Kizy et al even showed that surgical resection of lymph node positive ICC does not improve survival when compared with chemotherapy alone [ 45 ]. Others, however, have demonstrated better survival after lymph node dissection in case of lymph node negativity [ 46 ]. In summary, the positive effect of lymph node dissections for patient survival after resection of ICC remains highly questionable.…”

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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“…The goal of surgery is complete (R0) resection. The prevalence of LNM in ICC is as high as 17%-39.1% [15,16] , and LND is considered as part of R0 resection. Many surgeons believe that LND improves ICC survival.…”

Section: Discussionmentioning

confidence: 99%

“…compared the effect of LND on prognosis in patients with no suspected LNM before surgery [15] . This indicated that LND improved both DFS and OS in the nLND group.…”

Section: Discussionmentioning

confidence: 99%

Problems of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study Using Inverse Probability of Treatment Weighting.

Zhao

et al. 2020

Preprint

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Background Lymph node dissection (LND) is considered to improve the prognosis of patients with intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the role of LND remains controversial. This study aimed to explore the effect of LND on the prognosis of patients with ICC from two Chinese centers.MethodsPatients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).ResultsOf 251 patients, 189 (75.2%) underwent LND, and 72 (38%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 67 patients (35.5%). Lymph node metastasis (LNM) was a risk factor with a high hazard ratio. There was no association between LND and OS after IPTW; however, LND may affect the DFS. Tumors in the LNM group were more malignant, and surgical trauma was greater in the LNM group.ConclusionsOnly a few LNDs meet the NCCN guidelines’ requirements. LND did not improve prognosis, with higher surgical trauma. The best approach for LND requires further discussion.

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Prognostic value of lymphadenectomy for long-term outcomes in node-negative intrahepatic cholangiocarcinoma: A multicenter study

Cited by 52 publications

References 33 publications

The Clinical Value of Regional Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Results of A Retrospective Cohort Study

The Clinical Value of Regional Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Results of A Retrospective Cohort Study

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

Problems of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study Using Inverse Probability of Treatment Weighting.

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