Skip to main content

Advertisement

SpringerLink
Log in

Lymph Node Examination and Patterns of Nodal Metastasis Among Patients with Left- Versus Right-Sided Intrahepatic Cholangiocarcinoma After Major Curative-Intent Resection

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

Abstract

Background

We sought to investigate whether the unique lateral patterns of lymphatic drainage impacted lymphadenectomy (LND), lymph node metastasis (LNM), and long-term survival of patients after curative hemi-hepatectomy for left- versus right-sided intrahepatic cholangiocarcinoma (ICC).

Methods

Data on patients who underwent curative hemi-hepatectomy for left- or right-sided ICC were collected from 15 high-volume centers worldwide, as well as from the Surveillance, Epidemiology, and End Results (SEER) registry. Primary outcomes included overall survival (OS) and disease-free survival (DFS).

Results

Among 697 patients identified from the multi-institutional database, patients who underwent hemi-hepatectomy for left-sided ICC (n = 363, 52.1%) were more likely to have an increased number of LND versus patients with right-sided ICC (n = 334, 47.9%) (median, left 5 versus right 3, p = 0.012), although the frequency (left 66.4% versus right 63.8%, p = 0.469) and station (beyond station no. 12, left 25.3% versus right 21.1%, p = 0.293) were similar. Consequently, left-sided ICC was associated with higher incidence of LNM (left 33.3% versus right 25.7%, p = 0.036), whereas the station and number of LNM were not different (both p > 0.1). There was no difference in OS (median, left 34.9 versus right 29.6 months, p = 0.130) or DFS (median, left 14.5 versus right 15.2 months, p = 0.771) among patients who underwent hemi-hepatectomy for left- versus right-sided ICC, which were also verified in the SEER dataset. LNM beyond station no. 12 was associated with even worse long-term survival versus LNM within station no. 12 among patients with either left- or right-sided ICC after curative-intent resection (all p < 0.05).

Conclusions

The unique lateral patterns of lymphatic drainage were closely related to utilization of LND, as well as LNM of left- versus right-sided ICC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Zhang XF, Xue F, Dong DH, et al. Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis. Ann Surg. 2021;274:e1187–95.

    Article  Google Scholar 

  2. Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268–89.

    Article  Google Scholar 

  3. Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg. 2014;149:565–74.

    Article  Google Scholar 

  4. Spolverato G, Kim Y, Alexandrescu S, et al. Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative-intent surgical resection. Ann Surg Oncol. 2016;23:235–43.

    Article  Google Scholar 

  5. Hyder O, Hatzaras I, Sotiropoulos GC, et al. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153:811–8.

    Article  Google Scholar 

  6. Sulpice L, Rayar M, Boucher E, Pracht M, Meunier B, Boudjema K. Treatment of recurrent intrahepatic cholangiocarcinoma. Br J Surg. 2012;99:1711–7.

    Article  CAS  Google Scholar 

  7. Amini N, Ejaz A, Spolverato G, Maithel SK, Kim Y, Pawlik TM. Management of lymph nodes during resection of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: a systematic review. J Gastrointest Surg. 2014;18:2136–48.

    Article  Google Scholar 

  8. de Jong MC, Nathan H, Sotiropoulos GC, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29:3140–5.

    Article  Google Scholar 

  9. Tsuji T, Hiraoka T, Kanemitsu K, Takamori H, Tanabe D, Tashiro S. Lymphatic spreading pattern of intrahepatic cholangiocarcinoma. Surgery. 2001;129:401–7.

    Article  CAS  Google Scholar 

  10. Zhang XF, Chakedis J, Bagante F, et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg. 2018;105:857–66.

    Article  Google Scholar 

  11. Zhang XF, Chen Q, Kimbrough CW, et al. Lymphadenectomy for intrahepatic cholangiocarcinoma: has nodal evaluation been increasingly adopted by surgeons over time? A national database analysis. J Gastrointest Surg. 2018;22:668–75.

    Article  Google Scholar 

  12. Amin MB. American Joint Committee on Cancer. New York: Springer; 2017.

    Google Scholar 

  13. Frenkel NC, Poghosyan S, Verheem A, et al. Liver lymphatic drainage patterns follow segmental anatomy in a murine model. Sci Rep. 2020;10:21808.

    Article  CAS  Google Scholar 

  14. van den Bent L, Frenkel NC, Poghosyan S, et al. Liver lymphatic drainage patterns follow segmental anatomy. Br J Surg. 2022;109:559–60.

    Article  Google Scholar 

  15. Reames BN, Ejaz A, Koerkamp BG, et al. Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis. J Surg Oncol. 2017;116:133–9.

    Article  Google Scholar 

  16. Weber SM, Ribero D, O’Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015;17:669–80.

    Article  Google Scholar 

  17. Amin MB. American Joint Committee on Cancer: AJCC Cancer Staging Manual. 8th edn. New York: Springer; 2017.

    Book  Google Scholar 

  18. Vitale A, Moustafa M, Spolverato G, Gani F, Cillo U, Pawlik TM. Defining the possible therapeutic benefit of lymphadenectomy among patients undergoing hepatic resection for intrahepatic cholangiocarcinoma. J Surg Oncol. 2016;113:685–91.

    Article  Google Scholar 

  19. Zhang XF, Lv Y, Bagante F, et al. Should utilization of lymphadenectomy vary according to morphologic subtype of intrahepatic cholangiocarcinoma? Ann Surg Oncol. 2019;26:2242–50.

    Article  Google Scholar 

  20. Brierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours 8th (Edn). London: Wiley; 2017. p. 131–42.

    Google Scholar 

  21. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging: The Eighth Edition AJCC Cancer Staging Manual. CA: A Cancer J Clin. 2017;67(2):93–9. https://doi.org/10.3322/caac.21388.

    Article  Google Scholar 

  22. Jeong J, Tanaka M, Iwakiri Y. Hepatic lymphatic vascular system in health and disease. J Hepatol. 2022;77:206–18.

    Article  Google Scholar 

  23. Nakagawa T, Kamiyama T, Kurauchi N, et al. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg. 2005;29:728–33.

    Article  Google Scholar 

  24. Guglielmi A, Ruzzenente A, Campagnaro T, et al. Patterns and prognostic significance of lymph node dissection for surgical treatment of perihilar and intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2013;17:1917–28.

    Article  Google Scholar 

  25. Bagante F, Spolverato G, Weiss M, et al. (2017) Assessment of the lymph node status in patients undergoing liver resection for intrahepatic cholangiocarcinoma: the New Eighth Edition AJCC Staging System. J Gastrointest Surg. 22(1): 52–59.

  26. Ruzzenente A, Conci S, Vigano L, et al. Role of lymph node dissection in small (</= 3 cm) intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2019;23:1122–9.

    Article  Google Scholar 

  27. Bagante F, Gani F, Spolverato G, et al. Intrahepatic cholangiocarcinoma: prognosis of patients who did not undergo lymphadenectomy. J Am Coll Surg. 2015;221(1031–40):e1-4.

    Google Scholar 

Download references

Author information

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, 277 West Yanta Road, Xi’an, 710063, China

    Xu-Feng Zhang MD, PhD, Feng Xue MD & Yi Lv MD, PhD

  2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Xu-Feng Zhang MD, PhD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

  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, 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

    François Cauchy MD

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

    Guillaume Martel MD

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

    B. Groot Koerkamp MD

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

    Endo Itaru MD

  16. Department of Surgery, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA

    Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

Authors
  1. Xu-Feng Zhang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Feng Xue MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Weiss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Irinel Popescu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hugo P. Marques MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Aldrighetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shishir K. Maithel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlo Pulitano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Todd W. Bauer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Feng Shen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. George A. Poultsides MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. François Cauchy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Guillaume Martel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. B. Groot Koerkamp MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Endo Itaru MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yi Lv MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yi Lv MD, PhD or Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

Ethics declarations

DISCLOSURE

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

10434_2022_12797_MOESM1_ESM.tif

Supplementary file1 (Supplementary Figure 1: The overall (a) and disease-free survival (b) of patients who underwent curative hemi-hepatectomy and adequate LND (≥6) for left- versus right-sided intrahepatic cholangiocarcinoma) (TIF 364 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, XF., Xue, F., Weiss, M. et al. Lymph Node Examination and Patterns of Nodal Metastasis Among Patients with Left- Versus Right-Sided Intrahepatic Cholangiocarcinoma After Major Curative-Intent Resection. Ann Surg Oncol 30, 1424–1433 (2023). https://doi.org/10.1245/s10434-022-12797-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-12797-2

Search

Navigation