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Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 668–675 | Cite as

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

  • Xu-Feng Zhang
  • Qinyu Chen
  • Charles W. Kimbrough
  • Eliza W. Beal
  • Yi Lv
  • Jeffery Chakedis
  • Mary Dillhoff
  • Carl Schmidt
  • Jordan Cloyd
  • Timothy M. Pawlik
Original Article
  • 159 Downloads

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.

Keywords

Intrahepatic cholangiocarcinoma Lymphadenectomy Prognosis Seer 

Notes

Acknowledgements

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

Supplementary material

11605_2017_3652_Fig5_ESM.gif (40 kb)
Fig. S1

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

11605_2017_3652_MOESM1_ESM.tif (683 kb)
High Resolution Image (TIFF 683 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Xu-Feng Zhang
    • 1
    • 2
  • Qinyu Chen
    • 2
  • Charles W. Kimbrough
    • 2
  • Eliza W. Beal
    • 2
  • Yi Lv
    • 1
  • Jeffery Chakedis
    • 2
  • Mary Dillhoff
    • 2
  • Carl Schmidt
    • 2
  • Jordan Cloyd
    • 2
  • Timothy M. Pawlik
    • 2
  1. 1.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA

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