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Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea-Japan Study

 Chang Moo Kang  ;  Kyung-Suk Suh  ;  Nam-Joon Yi  ;  Tae Ho Hong  ;  Sang Jae Park  ;  Keun Soo Ahn  ;  Hiroki Hayashi  ;  Sae Byeol Choi  ;  Chi-Young Jeong  ;  Takeshi Takahara  ;  Shigehiro Shiozaki  ;  Young Hoon Roh  ;  Hee Chul Yu  ;  Takumi Fukumoto  ;  Ryusei Matsuyama  ;  Uyama Naoki  ;  Kazuki Hashida  ;  Hyung Il Seo  ;  Takehiro Okabayashi  ;  Tomoo Kitajima  ;  Sohei Satoi  ;  Hiroaki Nagano  ;  Hongbeom Kim  ;  Kaoru Taira  ;  Shoji Kubo  ;  Dong Wook Choi 
 CANCERS, Vol.13(3) : 445, 2021-01 
Journal Title
Issue Date
cholangiocarcinoma ; lymph nodes ; metastasis ; nomograms
Background: This study was performed to investigate the oncologic role of lymph node (LN) management and to propose a surgical strategy for treating intrahepatic cholangiocarcinoma (IHCC). Methods: The medical records of patients with resected IHCC were retrospectively reviewed from multiple institutions in Korea and Japan. Short-term and long-term oncologic outcomes were analyzed according to lymph node metastasis (LNM). A nomogram to predict LNM in treating IHCC was established to propose a surgical strategy for managing IHCC. Results: A total of 1138 patients were enrolled. Of these, 413 patients underwent LN management and 725 did not. A total of 293 patients were found to have LNM. The No. 12 lymph node (36%) was the most frequent metastatic node, and the No. 8 lymph node (21%) was the second most common. LNM showed adverse long-term oncologic impact in patients with resected IHCC (14 months, 95% CI (11.4-16.6) vs. 74 months, 95% CI (57.2-90.8), p < 0.001), and the number of LNM (0, 1-3, 4≤) was also significantly related to negative oncologic impacts in patients with resected IHCC (74 months, 95% CI (57.2-90.8) vs. 19 months, 95% CI (14.4-23.6) vs. 11 months, 95% CI (8.1-13.8)), p < 0.001). Surgical retrieval of more than four (≥4) LNs could improve the survival outcome in resected IHCC with LNM (13 months, 95% CI (10.4-15.6)) vs. 30 months, 95% CI (13.1-46.9), p = 0.045). Based on preoperatively detectable parameters, a nomogram was established to predict LNM according to the tumor location. The AUC was 0.748 (95% CI: 0.706-0.788), and the Hosmer and Lemeshow goodness of fit test showed p = 0.4904. Conclusion: Case-specific surgical retrieval of more than four LNs is required in patients highly suspected to have LNM, based on a preoperative detectable parameter-based nomogram. Further prospective research is needed to validate the present surgical strategy in resected IHCC.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
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