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Extent of Lymph Node Dissection for Accurate Staging in Intrahepatic Cholangiocarcinoma

Authors
 Sung Hyun Kim  ;  Dai Hoon Han  ;  Gi Hong Choi  ;  Jin Sub Choi  ;  Kyung Sik Kim 
Citation
 JOURNAL OF GASTROINTESTINAL SURGERY, Vol.26(1) : 70-76, 2022-01 
Journal Title
JOURNAL OF GASTROINTESTINAL SURGERY
ISSN
 1091-255X 
Issue Date
2022-01
MeSH
Bile Duct Neoplasms* / pathology ; Bile Duct Neoplasms* / surgery ; Bile Ducts, Intrahepatic / pathology ; Cholangiocarcinoma* / pathology ; Cholangiocarcinoma* / surgery ; Humans ; Lymph Node Excision ; Lymph Nodes / pathology ; Lymph Nodes / surgery ; Neoplasm Staging ; Prognosis ; Retrospective Studies
Keywords
Intrahepatic cholangiocarcinoma ; Lymph node excision ; Lymphatic metastasis ; Neoplasm staging ; Treatment outcome
Abstract
Background: Although lymph node metastasis is a known factor predictive of a poor prognosis after radical surgery for intrahepatic cholangiocarcinoma (ICC), few studies have investigated lymph node dissection (LND) areas for accurate staging. The aim of this study was to identify the optimal LND level for ICC considering lymphatic flow.

Methods: Clinical characteristics and pathologic nodal status (presence of metastasis) for 163 patients were reviewed according to tumor location. In the node-positive (N1) group, the distribution of metastatic nodes was described. The coverage of metastatic nodes according to dissection level was assessed, and the minimum dissection level for accurate ICC staging was estimated accordingly. For validation, the node-negative (N0) group was divided into two subgroups according to the estimated dissection level, and survival outcomes were compared.

Results: In the N1 group, expanding dissection to stations no. 12 and 8 covered 82.0% (n = 50) of metastatic cases regardless of tumor location. In survival analysis of N0 group, patients who underwent LND covering stations no. 8+12 showed better disease-free survival (DFS) and overall survival (OS), although the differences were not statistically significant (DFS: covering no. 12+8 vs. not covering no. 12+8, 109.0 months [24.2-193.8] vs. 33.0 months [10.3-55.7], p = 0.078; OS: covering no. 12+8 vs. not covering no. 12+8, 180.0 months [21.6-338.4] vs. 73.0 months [42.8-103.2], p = 0.080).

Conclusion: LND including at least stations no. 12 (hepatoduodenal ligament) and 8 (common hepatic artery), regardless of tumor location, is recommended for accurate staging in ICC patients.
Full Text
https://link.springer.com/article/10.1007/s11605-021-05039-5
DOI
10.1007/s11605-021-05039-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Sung Hyun(김성현) ORCID logo https://orcid.org/0000-0001-7683-9687
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
Han, Dai Hoon(한대훈) ORCID logo https://orcid.org/0000-0003-2787-7876
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187919
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