Abstract
Background
The therapeutic role of lymphadenectomy (LND) for intrahepatic cholangiocarcinoma
(ICC) patients remains ill-defined. We sought to analyze the therapeutic value of
LND relative to tumor location and preoperative lymph node metastasis (LNM) risk.
Methods
Patients who underwent curative-intent hepatic resection of ICC between 1990 and 2020
were included from a multi-institutional database. Therapeutic LND (tLND) was defined
as LND that harvested ≥3 lymph nodes.
Results
Among 662 patients, 178 (26.9%) individuals received tLND. Patients were categorized
into central type ICC (n = 156, 23.6%) and peripheral type ICC (n = 506, 76.4%). Central
type harbored multiple adverse clinicopathologic factors and worse overall survival
(OS) compared with peripheral type (5-year OS, central: 27.0% vs. peripheral: 47.2%,
p < 0.001). After consideration of preoperative LNM risk, patients with central type
and high-risk LNM who underwent tLND survived longer than individuals who did not
(5-year OS, tLND: 27.9% vs. non-tLND: 9.0%, p = 0.001), whereas tLND was not associated
with better survival among patients with peripheral type ICC or low-risk LNM. The
therapeutic index of hepatoduodenal ligament (HDL) and other regions was higher in
central type than in peripheral type, which was more pronounced among high-risk LNM
patients.
Conclusions
Central type ICC with high-risk LNM should undergo LND involving regions beyond the
HDL.
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Article info
Publication history
Published online: February 21, 2023
Accepted:
February 20,
2023
Received:
November 16,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
