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Role of Lymph Node Dissection in Small (≤ 3 cm) Intrahepatic Cholangiocarcinoma

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background and Aims

The role of lymph node dissection (LND) in patients with small intrahepatic cholangiocarcinoma (ICC) is still under debate.

The aims of this study were to compare the lymph node (LN) status and its correlation with survival among patients with ICC stratified by tumor size.

Methods

A retrospective analysis of a multi-institutional series of 259 patients undergoing curative-intent surgery was carried out. Patients were stratified into Small-ICC (≤ 3 cm) and Large-ICC (> 3 cm) based on tumor size.

Results

There were 53 and 206 patients in Small-ICC and Large-ICC groups, respectively. The incidence of LND was 62% among Small-ICC patients and 78% among Large-ICC patients (p = 0.016). LN metastases were identified in 30.3% and 38.5% of Small-ICC and Large-ICC patients, respectively (p = 0.37). No differences in terms of number of harvested LN and LN metastases were identified comparing Small- and Large-ICC patients. The 5-year overall survival (OS) was 52.6% for Small-ICC and 36.2% for Large-ICC (p = 0.024). The 5-year OS according to the LN status (N0 vs N+) was 84.8% and 36.0% (p = 0.032) in Small-ICC, and 45.7% and 12.1% in Large-ICC (p < 0.001), respectively.

Conclusion

While Small-ICC patients with no LN metastasis had a good long-term survival, the LN resulted in an important variable associated with survival also for patients in this group. Moreover, the incidence of LN metastasis did not differ when comparing Small-ICC and Large-ICC patients, suggesting that LND is mandatory in the surgical treatment of ICC regardless of tumor size.

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Authors and Affiliations

  1. General and Hepatobiliary Surgery, Department of Surgery, School of Medicine, University of Verona, Piazzale L. Scuro, 10, 37134, Verona, Italy

    Andrea Ruzzenente, Simone Conci, Serena Manfreda, Fabio Bagante, Andrea Ciangherotti, Antonio D. Pinna, Calogero Iacono & Alfredo Guglielmi

  2. Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy

    Luca Viganò, Giorgio Ercolani & Corrado Pedrazzani

  3. Department of General and Emergency Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Guido Torzilli

Authors
  1. Andrea Ruzzenente
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  2. Simone Conci
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  3. Luca Viganò
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  5. Serena Manfreda
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  6. Fabio Bagante
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  8. Corrado Pedrazzani
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  9. Antonio D. Pinna
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  12. Alfredo Guglielmi
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Corresponding author

Correspondence to Calogero Iacono.

Ethics declarations

Data collection and analysis were performed according to the institutional guidelines and were conformed to the ethical standards of the World Medical Association (Declaration of Helsinki). The study was approved by each local ethical committee, and signed consent was obtained from all the subjects included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Electronic Supplementary Material

Figure S1

Overall survival between Large-ICC and Small-ICC according to the different LN Status: A, N0 (p = 0.028); B, N+ (p = 0.048); C, NX (p = 0.985). (PPTX 3715 kb)

Figure S2

Overall survival between Large-ICC and Small-ICC according to the different LN Status (N0, N+ and NX) (p = 0.001). (PPTX 1272 kb)

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Ruzzenente, A., Conci, S., Viganò, L. et al. Role of Lymph Node Dissection in Small (≤ 3 cm) Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 23, 1122–1129 (2019). https://doi.org/10.1007/s11605-019-04108-0

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  • DOI: https://doi.org/10.1007/s11605-019-04108-0

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