Prognostic value of lymphadenectomy in node-negative intrahepatic cholangiocarcinoma: A multicenter,retrospectively study |
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| Affiliation: | 1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi''an Jiaotong University, Xi''an 710061, China;2. Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China;3. Department of Biliary Surgery, Eastern Hepatobiliary Hospital Affiliated to Naval Medical University, Shanghai 200433, China;4. Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital, Tianjin 300060, China;5. Department of Hepatobiliary Surgery, Hunan Provincial People''s Hospital, Changsha 410005, China;6. Department of Hepatobiliary Surgery, The First Hospital Affiliated to Army Medical University, Chongqing 400038, China;7. Department of Hepatobiliary Surgery, Zhongda Hospital of Southeast University, Nanjing 210009, China;8. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China;9. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;10. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China |
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| Abstract: | BackgroundThis study aimed to evaluate the prognostic value of lymph node dissection (LND) in node-negative intrahepatic cholangiocarcinoma (ICC) and identify the appropriately total number of lymph nodes examined (TNLE).MethodsData from node-negative ICC patients who underwent curative intent resection in ten Chinese hepatobiliary centers from January 2010 to December 2018 were collected. Overall survival (OS), relapse-free survival (RFS) and postoperative complications were analyzed. Propensity score matching (PSM) was performed to reduce the bias due to confounding variables in LND group and non-lymph node dissection (NLND) group. The optimal TNLE was determined by survival analysis performed by the X-tile program using the enumeration method.ResultsA total of 637 clinically node-negative ICC patients were included in this study, 74 cases were found lymph node (LN) positive after operation. Among the remaining 563 node-negative ICC patients, LND was associated with longer OS but not RFS before PSM (OS: 35.4 vs 26.0 months, p = 0.047; RFS: 15.0 vs 15.4 months, p = 0.992). After PSM, patients in LND group had better prognosis on both OS and RFS (OS: 38.0 vs 23.0 months, p < 0.001; RFS: 15.0 vs 13.0 months, p = 0.029). There were no statistically differences in postoperative complications. When TNLE was greater than 8, OS (48.5 vs 31.1 months, p = 0.025) and RFS (21.0 vs 13.0 months, p = 0.043) were longer in the group with more dissected LNs.ConclusionRoutinely LND for node-negative ICC patients is recommended for it helps accurate tumor staging and associates with better prognosis. The optimal TNLE is more than 8. |
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| Keywords: | Intrahepatic cholangiocarcinoma Lymph node dissection Node-negative Total number of lymph nodes examined Curative intent resection |
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