Advertisement

Surgery Today

, Volume 42, Issue 2, pp 147–151 | Cite as

Clinical impact of lymph node dissection in surgery for peripheral-type intrahepatic cholangiocarcinoma

  • Yuji Morine
  • Mitsuo Shimada
  • Tohru Utsunomiya
  • Satoru Imura
  • Tetsuya Ikemoto
  • Hiroki Mori
  • Jun Hanaoka
  • Mami Kanamoto
  • Hidenori Miyake
Original Article

Abstract

Purpose

To investigate the prognostic factors of peripheral-type intrahepatic cholangiocarcinoma (PP-IHCC) and evaluate the surgical outcomes according to surgical strategy alterations.

Methods

Twenty-two patients were divided into two groups according to the surgical strategy: an extended surgery group (Ex group: n = 10), composed of those who underwent hepatic lobectomy combined with lymph node (LN) dissection and bile duct resection; and a customized surgery group (Cx group: n = 12), composed of those who underwent hepatectomy and bile duct resection according to tumor spread. LN dissection was not performed in patients without LN metastasis.

Results

Multivariate analysis revealed that R2 resection, LN metastasis, and intrahepatic metastasis were independent prognostic factors. LN dissection was significantly infrequent in the Cx group. Survival after curative resection was similar in the two groups (3-year survival: 42.9 vs. 57.1%). Liver metastasis was the most frequent primary recurrence, occurring in more than 80% of patients from both groups.

Conclusions

Curative surgery might improve the prognosis of patients with PP-IHCC, but routine LN dissection is not recommended, particularly for patients without LN metastasis. Surgery alone, including LN dissection, cannot control this type of tumor, and additional treatment should be given.

Keywords

Intrahepatic cholangiocarcinoma Peripheral type Lymph node dissection Customized surgery Extended surgery 

References

  1. 1.
    The Liver Study Group of Japan. The 16th report: surveillance of primary liver cancer patients in National Registry. Kyoto: LCSGJ; 2005.Google Scholar
  2. 2.
    Washburn WK, Lewis WD, Jenkins RL. Aggressive surgical resection for cholangiocarcinoma. Arch Surg. 1995;130:270–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Roayaie S, Guarrena JV, Ye MQ, Thung SN, Emre S, Fishbein TM, et al. Aggressive surgical treatment of intrahepatic cholangiocarcinoma: predictors of outcomes. J Am Coll Surg. 1998;187:365–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Kacznski J, Hanson G, Wallerstedt S. Incidence, etiologic aspects and clinicopathological features in intrahepatic cholangiocarcinoma: a study of 51 cases from a low endemicity area. Acta Oncol. 1988;37:77–83.Google Scholar
  5. 5.
    Shimada M, Sugimoto K, Iwahashi S, Utsunomiya T, Morine Y, Imura S, et al. CD133 expression is a potential prognostic indicator in intrahepatic cholangiocarcinoma. J Gastroenterol. 2010;45:896–902.PubMedCrossRefGoogle Scholar
  6. 6.
    Chu KM, Lai ECS, Al-Hadeede S, Arcilla CE Jr, Lo CM, Liu CL, et al. Intrahepatic cholangiocarcinoma. World J Surg. 1997;21:301–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Casavila FA, Marsh JW, Iwatsuki S, Todo S, Lee RG, Madariaga R, et al. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg. 1997;185:429–36.Google Scholar
  8. 8.
    Chou FF, Sheen-Chen SM, Chen YS, Chen MC, Chen CL. Surgical treatment of cholangiocarcinoma. Hepatogastroenterology. 1997;44:760–5.PubMedGoogle Scholar
  9. 9.
    Hasegawa K, Kokudo N. Surgical treatment of hepatocellular carcinoma. Surg Today. 2009;39:833–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Yamamoto M, Takasaki K, Otsubo T, Katsuragawa H, Katagiri S. Recurrence after surgical resection of intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2001;8:154–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Miwa S, Miyagawa S, Kobayashi A, Akahane Y, Nakata T, Mihara M, et al. Predictive factors for intrahepatic cholangiocarcinoma recurrence in the following surgery. J Gastroenterol. 2006;41:893–900.PubMedCrossRefGoogle Scholar
  12. 12.
    Uenishi T, Kubo S, Yamazaki O, Yamada T, Sasaki Y, Nagano H, et al. Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastasis. J Hepatobiliary Pancreat Surg. 2008;15:417–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Inoue K, Makuuchi M, Takayama T, Torzilli G, Yamamoto J, Shimada K, et al. Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery (St. Louis). 2000;127(5):498–505.CrossRefGoogle Scholar
  14. 14.
    Shimada M, Yamashita Y, Aishima S, Shirabe K, Takenaka K, Sugimachi K. Value of lymph nodes dissection during resection of intrahepatic cholangiocarcinoma. Br J Surg. 2001;88:1463–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Liver Cancer Study Group of Japan. Classification of primary liver cancer, 1st English edition. Tokyo: Kanehara; 1997.Google Scholar
  16. 16.
    Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K, Kondo S, et al. Aggressive surgical treatment of hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 1998;5:52–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Shirabe K, Shimada M, Harimoto N, Sugimachi K, Yamashita Y, Tsujita E, et al. Intrahepatic cholangiocarcinoma: its mode of spreading and therapeutic modalities. Surgery (St. Louis). 2002;131(1 suppl):S159–64.CrossRefGoogle Scholar
  18. 18.
    Uenishi T, Hirohashi K, Kubo S, Yamamoto T, Yamazaki O, Kinoshita H. Clinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma. Br J Surg. 2001;88:969–74.PubMedCrossRefGoogle Scholar
  19. 19.
    Inoue K, Makuuchi M, Takayama T, Torzilli G, Yamamoto J, Shimada K, et al. Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery (St. Louis). 2000;127:498–505.CrossRefGoogle Scholar
  20. 20.
    Shimada K, Sano T, Nara S, Esaki M, Sakamoto Y, Kosuge T, et al. Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery (St. Louis). 2009;145:411–6.CrossRefGoogle Scholar
  21. 21.
    Morimoto Y, Tanaka Y, Ito T, Nakahara M, Nakaba H, Nishida T, et al. Long-term survival and prognostic factors in the surgical treatment for intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2003;10:432–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, et al. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg. 2002;89:1525–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H, et al. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg. 2005;29:728–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Suzuki S, Sakaguchi T, Yokoi Y, Okamoto K, Kurachi K, Tsuchiya Y, et al. Clinicopathological prognostic factors and impact of surgical treatment of mass-forming intrahepatic cholangiocarcinoma. World J Surg. 2002;26:687–93.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Yuji Morine
    • 1
  • Mitsuo Shimada
    • 1
  • Tohru Utsunomiya
    • 1
  • Satoru Imura
    • 1
  • Tetsuya Ikemoto
    • 1
  • Hiroki Mori
    • 1
  • Jun Hanaoka
    • 1
  • Mami Kanamoto
    • 1
  • Hidenori Miyake
    • 1
  1. 1.Department of SurgeryInstitute of Health Biosciences, The University of Tokushima Graduate SchoolTokushimaJapan

Personalised recommendations