The mode of lymphatic spread in carcinoma of the bile duct

Kurosaki, Isao; Tsukada, Kazuhiro; Hatakeyama, Katsuyoshi; Muto, Terukazu

doi:10.1016/s0002-9610(96)00156-0

Cited by 38 publications

(27 citation statements)

References 13 publications

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“…The incidence of lymph node metastasis in cholangiocarcinoma increases with increasing depth of carcinoma invasion in the primary tumor. 8,11,[22][23][24] We also showed a correlation between primary tumor extension and nodal involvement. The nodepositive rate in our patients with pT3 disease exceeded 60%.…”

Section: Discussionsupporting

confidence: 53%

“…The celiac and superior mesenteric nodes are classified as regional nodes in extrahepatic bile duct cancer according to the TNM system. This might be true in distal bile duct cancer, 22,23 but it is not the case in proximal bile duct cancer. In hilar cholangiocarcinoma, the celiac and superior mesenteric nodes should be classified as distant nodes.…”

Section: Discussionmentioning

confidence: 98%

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Lymph Node Metastasis from Hilar Cholangiocarcinoma: Audit of 110 Patients Who Underwent Regional and Paraaortic Node Dissection

et al. 2001

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ObjectiveTo assess the status of the regional and paraaortic lymph nodes in hilar cholangiocarcinoma and to clarify the efficacy of systematic extended lymphadenectomy. Summary Background DataThere have been no studies in which regional and paraaortic lymphadenectomies for hilar cholangiocarcinoma have been routinely performed. Therefore, the metastasis rates to the regional and paraaortic nodes, the mode of lymphatic spread, and the effect of extended lymph node dissection on survival remain unknown. MethodsThis study involved 110 patients who underwent surgical resection for hilar cholangiocarcinoma with lymph node dissection including both the regional and paraaortic nodes. A total of 2,652 nodes retrieved from the surgical specimens were examined microscopically.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 98%

Lymph Node Metastasis from Hilar Cholangiocarcinoma: Audit of 110 Patients Who Underwent Regional and Paraaortic Node Dissection

et al. 2001

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“…Fifty patients with Bm and Bi disease (Bm 14 patients, Bi 36 patients) were examined histopathologically. A precise determination was made of lymph node involvement and neural plexus invasion.…”

Section: Methodsmentioning

confidence: 99%

“…Thirteen (36%) of these 36 patients were alive at 5 years. However, of 14 patients with tumor present at a resection margin, there were no survivors beyond 43 months.…”

Section: Survivalmentioning

confidence: 97%

Role of Nodal Involvement and the Periductal Soft-Tissue Margin in Middle and Distal Bile Duct Cancer

Kayahara

Nagakawa²,

Ohta³

et al. 1999

Annals of Surgery

136

106

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ObjectiveTo determine the pattern of middle (Bim) and distal (Bi) bile duct cancers in an attempt to optimize surgical treatment. Summary Background DataLymph node involvement and neural plexus invasion are the prognostic factors most amenable to surgery in Bm and Bi disease. However, a detailed analysis of these factors has not been conducted. MethodsFifty patients with Bm and Bi disease (Bm 14 patients, Bi 36 patients) were examined histopathologically. A precise determination was made of lymph node involvement and neural plexus invasion. Important prognostic factors were examined by clinicopathologic study to apply these findings to surgical management. ResultsFrequencies of nodal involvement for Bm and Bi disease were 57% and 71 %, respectively. The inferior periductal and superior pancreaticoduodenal lymph nodes were most commonly involved. Neural plexus invasion occurred in 20% of patients, particularly involving the plexus in the hepatoduodenal ligament and pancreatic head. Tumor was present at the surgical margin in 50% and 14% of patients with Bm and Bi disease, respectively. Five-year survival rates were 65% in the absence of nodal metastasis and 21 % with nodal metastasis. A significant correlation existed between absence of tumor at the surgical margin and survival. A Cox proportional hazard model projected absence of tumor at the surgical margin, followed by nodal involvement, as the strongest prognostic variables. ConclusionsAbsence of tumor at the surgical margin and nodal involvement are important independent prognostic factors in Bm and Bi disease. Skeletonization of the hepatoduodenal ligament, including portal vein resection, is necessary for patients with Bm disease, and a wide nodal dissection is essential in all patients.The survival rate for periampullary carcinoma is low among the malignant gastrointestinal diseases. The prognosis of bile duct cancer is better than that of carcinoma of the head of the pancreas.' Pancreatobiliary carcinoma is characterized by tumor spread by neural invasion and lymph node metastasis.24 Nodal involvement and nerve plexus invasion are important prognostic factors that may be surgically resectable. We already have reported that a radical resection is necessary for pancreatobiliary cancer.26 However, even after curative surgery, some patients still have recurrence.The goal of the current study was to determine the pattern of tumor spread, including nodal involvement and nerve plexus invasion, and other factors that may affect long-term survival. We also discuss the implications for the surgical treatment of carcinoma of the middle or distal bile duct.Address reprint requests to Masato Kayahara, MD, PhD, The Second

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“…As a consequence of such initial results and the limited availability of organs, HCC was perceived as a relative contraindication to OLT. Also, it is a well-known fact that 55% of HCC even in T2 stages have affected LN, which is one of the contraindications to transplant [97] . A further complication to transplants in HCC is that, as response to postoperative radiotherapy and chemotherapy is low both in R1 and recurrence, tumors must have a more favourable biological behaviour, and if sizes bigger than 2 cm are rejected for rescue with liver transplant, then very few patients can be candidates to be transplanted [52] .…”

Section: Hilar Cholangiocarcinoma No Of Patients Prognostic Factors mentioning

confidence: 99%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery. INTRODUCTIONCarcinomas arising from the confluence of the hepatic ducts were first described by Altemeier et al [1] . Klatskin [2] Alejandro Serrablo, Luis Tejedor Outcome of surgical resection in Klatskin tumors TOPIC HIGHLIGHT AbstractCholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc .) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Conclusion: Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal José M Ramia, MD, PhD, Series Editor

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The mode of lymphatic spread in carcinoma of the bile duct

Cited by 38 publications

References 13 publications

Lymph Node Metastasis from Hilar Cholangiocarcinoma: Audit of 110 Patients Who Underwent Regional and Paraaortic Node Dissection

Lymph Node Metastasis from Hilar Cholangiocarcinoma: Audit of 110 Patients Who Underwent Regional and Paraaortic Node Dissection

Role of Nodal Involvement and the Periductal Soft-Tissue Margin in Middle and Distal Bile Duct Cancer

Outcome of surgical resection in Klatskin tumors

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