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Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Has Nodal Evaluation Been Increasingly Adopted by Surgeons over Time?A National Database Analysis

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Surgical management of intrahepatic cholangiocarcinoma routinely includes resection of the hepatic parenchyma, yet the role of lymphadenectomy (LND) is more controversial. The objective of the current study was to define overall utilization, as well as temporal trends, in the utilization of LND among patients undergoing curative-intent hepatectomy for ICC using a nationwide database.

Materials and Methods

One thousand four hundred ninety-six patients who underwent curative-intent resection for ICC were identified using the SEER database from 2000 to 2013. The utilization of LND was assessed over time and by geographic region. LND utilization and the incidence of lymph node metastasis (LNM) were evaluated relative to AJCC T categories.

Results

At the time of surgery, slightly over one-half of patients (n = 784, 52.4%) had at least one LN evaluated. Specifically, 613 (41.0%) patients had 1–5 LNs evaluated, whereas 171 (11.4%) patients had ≥ 6 LNs evaluated. The proportion of patients who had at least one LN evaluated at the time of surgery did not change with time (2000–2004: 50.5% vs. 2005–2009: 52.0% vs. 2010–2013: 53.7%) (p = 0.636). In contrast, the proportion of patients who had ≥ 6 LNs examined did increase (2000–2004: 6.9% vs. 2005–2009: 10.6% vs. 2009–2013: 14.3%) (p = 0.003). The risk of LNM was higher among patients with advanced T category tumors (Referent T1; T2a: OR 4.2, 95% CI 2.0–8.8, p < 0.001; T2b: OR 2.4, 95% CI 1.1–4.9, p = 0.018; T3: OR 3.6, 95% CI 1.6–7.9, p = 0.001; T4: OR 2.2, 95% CI 1.0–4.9, p = 0.049). In addition, the portion of patients with LNM varied among the different T categories (T1, 23.2%, T2a, 55.3%, T2b, 42.0%, T3, 51.4%, and T4, 39.5%; p = 0.001).

Conclusions

Utilization of LND in the surgical management of ICC across the USA remained relatively low and did not change over the last decade. Selective utilization of LND may be problematic as T-stage was not a reliable predictor of nodal status with almost a quarter of patients with early stage disease having LNM.

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Acknowledgements

X.-F. Z. was supported in part by the China Scholarship Council.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xu-Feng Zhang & Yi Lv

  2. Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Xu-Feng Zhang, Qinyu Chen, Charles W. Kimbrough, Eliza W. Beal, Jeffery Chakedis, Mary Dillhoff, Carl Schmidt, Jordan Cloyd & Timothy M. Pawlik

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  1. Xu-Feng Zhang
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Correspondence to Timothy M. Pawlik.

Additional information

Synopsis: SEER data suggests that widespread adoption of routine lymphadenectomy (LND) during curative-intent surgery for intrahepatic cholangiocarcinoma has not occurred in the USA over the last decade.

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Fig. S1

Flow chart of study participant selection. ICC, intrahepatic cholangiocarcinoma (GIF 39 kb)

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Zhang, XF., Chen, Q., Kimbrough, C.W. et al. Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Has Nodal Evaluation Been Increasingly Adopted by Surgeons over Time?A National Database Analysis. J Gastrointest Surg 22, 668–675 (2018). https://doi.org/10.1007/s11605-017-3652-2

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