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Management of Lymph Nodes During Resection of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: A Systematic Review

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

The role of lymph node dissection (LND) in the treatment of patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) remains controversial. We sought to systematically review all available evidence to determine the role of LND in patients with HCC and ICC. Studies that reported on LND, lymph node metastasis (LNM), and short- and long-term outcomes for patients with HCC or ICC survival were identified from PubMed, Cochrane, Embase, Scopus, and Web of Science databases. Data were extracted, synthesized, and analyzed using standard techniques. A total of 603 and 434 references were identified for HCC and ICC, respectively. Among HCC patients, the overall prevalence of LND was 51.6 % (95 % confidence interval (CI) 19.7-83.5) with an associated LNM incidence of 44.5 % (95 % CI 27.4–61.7). LNM was associated with a 3- and 5-year survival of 27.5 and 20.8 %, respectively. Among ICC patients, most patients 78.5 % (95 % CI 76.2–80.7) underwent LND; 45.2 % (95 % CI 39.2–51.2) had LNM. Three and 5-year survival among ICC patients with LNM was 0.2 % (95 % CI 0–0.7) and 0 %, respectively. While there are insufficient data to recommend a routine LND in all patients with HCC or ICC, the potential prognostic value of LND suggests that LND should at least be considered at the time of surgery.

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Acknowledgments

Dr. Aslam Ejaz was supported, in part, by the Eleanor B. Pillsbury Foundation for surgical research.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    Neda Amini, Aslam Ejaz, Gaya Spolverato, Yuhree Kim & Timothy M. Pawlik

  2. Department of Surgery, University of Illinois Hospital and Health Sciences Center, Chicago, IL, USA

    Aslam Ejaz

  3. Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Shishir K. Maithel

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Correspondence to Timothy M. Pawlik.

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Amini, N., Ejaz, A., Spolverato, G. et al. Management of Lymph Nodes During Resection of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: A Systematic Review. J Gastrointest Surg 18, 2136–2148 (2014). https://doi.org/10.1007/s11605-014-2667-1

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