Faculty Collaboration Database

Intrahepatic Cholangiocarcinoma: Prognosis of Patients Who Did Not Undergo Lymphadenectomy. J Am Coll Surg 2015 Dec;221(6):1031-40.e1-4

Date

10/18/2015

Pubmed ID

26474514

DOI

10.1016/j.jamcollsurg.2015.09.012

Scopus ID

2-s2.0-84951791319 (requires institutional sign-in at Scopus site)   67 Citations

Abstract

BACKGROUND: The role of routine lymphadenectomy (LD) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) remains poorly defined. This study aimed to evaluate the role of routine LD as well as to quantify the impact of not assessing nodal station on disease-specific survival (DSS) among patients undergoing liver surgery for ICC.

STUDY DESIGN: Using data from 12 major hepatobiliary centers, 561 patients undergoing liver surgery for ICC between 1990 and 2012 were identified. The association between nodal status and DSS was assessed using Cox proportional and Aalen's linear hazards models.

RESULTS: Among the 272 (48.5%) patients who underwent LD, 123 (45.2%) had lymph node metastasis (N1). Although differences in DSS were noted between N0 and Nx patients within the first 18 months after surgery (DSS at 18 months: N0 vs Nx, 70.2% vs 60.6%, respectively, p = 0.019) among patients who had survived to 18 months, the DSS at 60 months of Nx patients was comparable to that of N0 patients (p = 0.48). Conversely, although the DSS of N1 and Nx patients was comparable in the short-term (DSS at 18 months: p = 0.13), among patients who had survived to 18 months, N1 patients had a lower DSS compared with Nx patients (DSS at 60 months among patients who had survived to 18 months: N1 vs Nx, 15.2% vs 45.8%, respectively, p < 0.001; all p values were based on the log-rank test comparing 2 survival curves).

CONCLUSIONS: Although Nx patients and N1 patients had comparable DSS in the short-term, Nx patients who survived past 18 months had a survival comparable to that of N0 patients. Lack of nodal staging may lead to heterogeneous and potentially incorrect prognostic classification of patients with ICC.

Author List

Bagante F, Gani F, Spolverato G, Xu L, Alexandrescu S, Marques HP, Lamelas J, Aldrighetti L, Gamblin TC, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Marsh JW, Pawlik TM

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Bile Duct Neoplasms
Cholangiocarcinoma
Combined Modality Therapy
Female
Hepatectomy
Humans
Lymph Node Excision
Male
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Survival Analysis