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

Abstract

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.

Surgical treatment of intrahepatic cholangiocarcinoma: a retrospective study of 104 cases

“…However, systematic lymphadenectomy may improve the outcomes of ICC if we identify the location of lymphatic metastasis 13 . Some researchers recommend that ICC patients without LNM should not undergo routine LND, and extended systemic LND is not recommended for ICC patients with LNM 14 . Therefore, this study analyzed LND and LNM as covariates.…”

Immune responses against tumour‐associated antigen‐derived cytotoxic T lymphocyte epitopes in cholangiocarcinoma patients

“…Cholangiocarcinoma is a rare malignant disease associated with a poor prognosis . Recent advancements in medical imaging techniques have led to an increase in the number of patients diagnosed with cholangiocarcinoma, with a higher incidence in East Asia . Operation at the early stage of the disease is the only curative option; however, most patients are diagnosed at advanced stages despite improvements in medical imaging techniques.…”

“…Operation at the early stage of the disease is the only curative option; however, most patients are diagnosed at advanced stages despite improvements in medical imaging techniques. Patients with metastatic cholangiocarcinoma have a particularly high risk for mortality, with a median survival of 8‐12 months even with combined modality therapy . A novel therapeutic approach is needed to improve the prognosis of cholangiocarcinoma patients.…”

“…1,2 Recent advancements in medical imaging techniques have led to an increase in the number of patients diagnosed with cholangiocarcinoma, with a higher incidence in East Asia. 1,2 Operation at the early stage of the disease is the only curative option; however, most patients are diagnosed at advanced stages despite improvements in medical imaging techniques. Patients with metastatic cholangiocarcinoma have a particularly high risk for mortality, with a median survival of 8-12 months even with combined modality therapy.…”

Defining the possible therapeutic benefit of lymphadenectomy among patients undergoing hepatic resection for intrahepatic cholangiocarcinoma

“…Various studies have identified patient and disease characteristics such as age at diagnosis, number of tumors, tumor size, and invasion of adjacent structures to be predictive of poor overall survival . More recently, several reports have also identified nodal status as a potentially useful prognostic indicator for ICC . However, the role of lymphadenectomy remains controversial and poorly defined with contrasting views between Eastern and Western centers .…”