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Surgical Management of Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Impact of Lymphadenectomy on Peri-Operative Outcomes

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Abstract

Background

The consequences of lymphadenectomy (LND) on cirrhotic patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC) have not been investigated. We sought to analyze the impact of LND on morbidity among patients undergoing resection for ICC.

Methods

A total of 1005 patients who underwent hepatectomy for ICC at one of the 14 participating institutions between 1990 and 2015 were identified. A propensity score match analysis was performed to reduce confounding biases between cirrhosis and non-cirrhosis groups.

Results

Cirrhosis was diagnosed in 118 (11.7%) patients. Among non-cirrhotic patients, 63% underwent major liver resection versus only 20% among patients with cirrhosis (p < 0.001). LND was also less common among cirrhotic versus non-cirrhotic patients (19 vs. 50%, p < 0.001). The incidence of complications was 41 and 30% among patients who did not and did have cirrhosis, respectively (p = 0.022). The propensity-matched cohort included 150 patients. The incidence of complications was 71% among patients who underwent lymphadenectomy versus 23% among patients who did not undergo lymphadenectomy (OR 8.39) (p < 0.001). In the propensity-matched analysis, the median HLN was comparable among patients independent of cirrhosis status (median HLN: non-cirrhosis, 2.5 vs. cirrhosis, 2) (p = 0.95). While lymphadenectomy was associated with a higher risk of infections (non-cirrhosis, 0% vs. cirrhosis, 21%, p < 0.001) among patients with cirrhosis, infections were not associated with lymphadenectomy among non-cirrhotic patients (p = 0.19).

Conclusion

Lymphadenectomy was associated with an increased risk of complications among patients with cirrhosis undergoing surgery for ICC. The benefit of lymphadenectomy in cirrhotic patients should be considered in light of the higher risk of postoperative complications compared with non-cirrhotic patients.

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Author notes

  1. Fabio Bagante and Gaya Spolverato have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Surgery, University of Verona, Verona, Italy

    Fabio Bagante, Gaya Spolverato, Alfredo Guglielmi & Andrea Ruzzenente

  2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss

  3. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu

  4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques

  5. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti

  6. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel

  7. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    Carlo Pulitano

  8. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer

  9. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen

  10. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  11. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France

    Olivier Soubrane

  12. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel

  13. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands

    B. Groot Koerkamp

  14. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan

    Endo Itaru

  15. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA

    Timothy M. Pawlik

Authors
  1. Fabio Bagante
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  2. Gaya Spolverato
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  3. Matthew Weiss
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  4. Sorin Alexandrescu
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  5. Hugo P. Marques
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  6. Luca Aldrighetti
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  7. Shishir K. Maithel
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  8. Carlo Pulitano
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  9. Todd W. Bauer
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  10. Feng Shen
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  11. George A. Poultsides
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  12. Olivier Soubrane
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  13. Guillaume Martel
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  14. B. Groot Koerkamp
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  15. Alfredo Guglielmi
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  16. Endo Itaru
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  17. Andrea Ruzzenente
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  18. Timothy M. Pawlik
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Corresponding author

Correspondence to Timothy M. Pawlik.

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Bagante, F., Spolverato, G., Weiss, M. et al. Surgical Management of Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Impact of Lymphadenectomy on Peri-Operative Outcomes. World J Surg 42, 2551–2560 (2018). https://doi.org/10.1007/s00268-017-4453-1

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  • DOI: https://doi.org/10.1007/s00268-017-4453-1

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