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Should Utilization of Lymphadenectomy Vary According to Morphologic Subtype of Intrahepatic Cholangiocarcinoma?

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

We sought to evaluate the utilization of lymphadenectomy (LND) and the incidence of lymph node metastasis (LNM) among different morphologic types of intrahepatic cholangiocarcinoma (ICC).

Methods

Clinical data of patients undergoing curative-intent resection for ICC between 1990 and 2017 were collected and analyzed. The preoperative nodal status was evaluated by imaging studies, and the morphologic and lymph node (LN) status was collected on final pathology report.

Results

Overall, 1032 patients had a mass-forming (MF) or intraductal growth (IG) ICC subtype, whereas 150 patients had a periductal infiltrating (PI) or MF + PI subtype. Among the 924 patients with MF/IG ICC subtype who had nodal assessment on preoperative imaging, 747 (80.8%) were node-negative, whereas 177 (19.2%) patients were suspicious for metastatic nodal disease. On final pathological analysis, 71 of 282 (25.2%) patients who had preoperative node-negative disease ultimately had LNM. In contrast, 79 of 135 (58.5%) patients with preoperative suspicious/metastatic LNs had pathologically confirmed LNM (odds ratio [OR] 4.2, p < 0.001). Among the 129 patients with PI/MF + PI ICC subtype and preoperative nodal information, 72 (55.8%) were node-negative on preoperative imaging. In contrast, 57 (44.2%) patients had suspicious/metastatic LNs. On final pathologic examination, 45.3% (n = 24) of patients believed to be node-negative on preoperative imaging had LNM; 68.0% (n = 34) of patients who had suspicious/positive nodal disease on imaging ultimately had LNM (OR 2.6, p = 0.009).

Conclusion

Given the low accuracy of preoperative imaging evaluation of nodal status, routine LND should be performed at the time of resection for both MF/IG and PI/MF + PI ICC subtypes.

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Acknowledgment

Xu-Feng Zhang was supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017-004).

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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 MD, PhD & Yi Lv MD, PhD

  2. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Xu-Feng Zhang MD, PhD & Timothy M. Pawlik MD, MPH, PhD

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

    Matthew Weiss MD

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

    Irinel Popescu MD

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

    Hugo P. Marques MD

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

    Luca Aldrighetti MD

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

    Shishir K. Maithel MD

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

    Carlo Pulitano MD

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

    Todd W. Bauer MD

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

    Feng Shen MD

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

    George A. Poultsides MD

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

    Oliver Soubrane MD

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

    Guillaume Martel MD

  14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands

    B. Groot Koerkamp MD

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

    Endo Itaru MD

  16. Department of Surgery, Oncology, Health Services Management and Policy, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD

Authors
  1. Xu-Feng Zhang MD, PhD
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  2. Yi Lv MD, PhD
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  3. Matthew Weiss MD
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  10. Feng Shen MD
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  15. Endo Itaru MD
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  16. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Disclosure

Xu-Feng Zhang, Yi Lv, Matthew Weiss, Irinel Popescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, Oliver Soubrane, Guillaume Martel, B. Groot Koerkamp, Endo Itaru, and Timothy M. Pawlik have no financial or commercial interests to disclose.

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Zhang, XF., Lv, Y., Weiss, M. et al. Should Utilization of Lymphadenectomy Vary According to Morphologic Subtype of Intrahepatic Cholangiocarcinoma?. Ann Surg Oncol 26, 2242–2250 (2019). https://doi.org/10.1245/s10434-019-07336-5

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  • DOI: https://doi.org/10.1245/s10434-019-07336-5

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