Surgical treatment for intrahepatic cholangiocarcinoma in Europe: a single center experience

Bektaş, H.; Yeyrek, Cemil; Kleine, Moritz; Vondran, Florian W. R.; Timrott, Kai; Schweitzer, Nóra; Vogel, Arndt; Jäger, Mark D.; Schrem, Harald; Klempnauer, Jürgen; Kousoulas, Lampros

doi:10.1002/jhbp.158

Cited by 48 publications

(36 citation statements)

References 31 publications

(48 reference statements)

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“…For intrahepatic cholangiocarcinoma (ICC) the importance and extension of lymphadenectomy is still in debate with a recommended number of six lymph nodes to be harvested currently. In different studies tumor positive lymph nodes had significant influence on long-term outcome [2][3][4][5][6][7][8]. In the recent literature factors regarding lymphadenectomy such as the total number of harvested lymph nodes, the number of malignant lymph nodes or positive LN to negative LN ratios are discussed extensively [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

et al. 2020

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Background: Intrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting in a low resectability rate. Even after potentially curative resection the risk for tumor recurrence is high. Although the extent and value of lymphadenectomy is part of ongoing discussion, the role of preoperative imaging for assessment of suspicious lymph nodes (suspLN) has only been studied modestly. Aim of this study is to demonstrate the influence of suspicious lymph nodes in preoperative imaging on resectability, recurrence, and long-term outcome.Methods: All patients who underwent exploration for ICC between January 2008 and June 2018 were included. Preoperative imaging (CT or MRI) was analysed with focus on suspLN at the hepatoduodenal ligament, lesser curvature, interaortocaval, and superior to the diaphragm; suspLN were classified according to the universally accepted RECIST 1.1 criteria; histopathology served as gold standard.Results: Out of 187 patients resection was performed in 137 (73.3%), in 50 patients the procedure was terminated after exploration. Overall, suspLN were found preoperatively in 73/187 patients (39%). Comparing patients who underwent resection and exploration only, suspLN were significantly more common in the exploration group (p = 0.011). Regarding lymph node stations, significant differences could be shown regarding resectability: All tumors with suspLN superior to the diaphragm were irresectable. Preoperative imaging assessment showed a strong correlation with final histopathology, especially of suspLN of the hepatoduodenal ligament and the lesser curvature. Sensitivity of suspLN was 71.1%, specificity 90.8%. Appearance of tumor recurrence was not affected by suspLN (p = 0.289). Using a short-axis cut-off of <> 1 cm, suspLN had significant influence on recurrence-free survival (RFS, p = 0.009) with consecutive 1-, 3-, and 5-year RFS of 41, 21, and 15% versus 29, 0, and 0%, respectively. Similarly, 1-, 3-and 5-year overall survival (OS) was 75, 30, and 18% versus 59, 18, and 6%, respectively (p = 0.040).

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Section: Introductionmentioning

confidence: 99%

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

et al. 2020

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“…The incidence in western countries increases up to 1/100.000 per year . Radical resection is the only curative treatment . However, high rates of non‐resectable tumours and recurrence after resection result in poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Radical resection is the only curative treatment. 4 However, high rates of non-resectable tumours and recurrence after resection result in poor prognosis. The TNM staging system of the American Joint Committee on Cancer (AJCC) and the International Union for Cancer Control (UICC) is widely used for staging of BTC.…”

Section: Introductionmentioning

confidence: 99%

Risk estimation for biliary tract cancer: Development and validation of a prognostic score

Schweitzer

Fischer

Kirstein

et al. 2017

Liver International

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“…LN metastasis, which was the most prominent malignant feature of IHCC, often occurs in either regional or distant areas, and is the greatest contributor to the negative clinical impact with much worse prognosis regardless of the induction of extended surgical treatment [13][14][15][16][17]. However, in a small number of patients, extended LN dissection has enhanced the long-term survival after curative surgical treatment [18].…”

Section: Introductionmentioning

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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Surgical treatment for intrahepatic cholangiocarcinoma in Europe: a single center experience

Cited by 48 publications

References 31 publications

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

Risk estimation for biliary tract cancer: Development and validation of a prognostic score

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

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