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Is Para-aortic Lymph Node Metastasis a Contraindication for Radical Resection in Biliary Carcinoma?

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Abstract

Background

Para-aortic nodal dissection in patients with biliary carcinoma has not been performed routinely worldwide. Therefore, the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma has not yet been evaluated. The aim of this study was to clarify the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma.

Methods

Of 113 patients with biliary adenocarcinoma who underwent surgical resection with regional and para-aortic lymph node dissection, para-aortic lymph node metastasis was found in 17 patients (15%) by final pathological examination. Relationships between clinicopathological factors, including para-aortic lymph node metastasis, and survival were analyzed by univariate and multivariate analyses.

Results

Overall survival rates for the 113 patients were 82% at 1 year, 65% at 2 years, 58% at 3 years, and 52% at 5 years. Univariate analysis revealed that better tumor differentiation (P = 0.044), negative lymph node metastasis (P < 0.001), negative para-aortic lymph node metastasis (P = 0.007), negative surgical margin status (P < 0.001), lower UICC pT factor (P = 0.009), and earlier UICC stage (P < 0.001) were associated significantly with longer survival. Lymph node metastasis (P = 0.004) but not para-aortic lymph node metastasis (P = 0.323) remained associated independently with longer survival by multivariate analysis. Five-year survival rates for node-negative patients, node-positive patients without para-aortic lymph node metastasis, and node-positive patients with para-aortic lymph node metastasis were 72, 31, and 24%, respectively.

Conclusion

Radical resection should not be abandoned for patients with para-aortic lymph node metastasis in biliary adenocarcinoma.

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Authors and Affiliations

  1. Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yoshiaki Murakami, Kenichiro Uemura, Takeshi Sudo, Yasushi Hashimoto, Akira Nakashima, Naru Kondo, Ryutaro Sakabe, Hironori Kobayashi & Taijiro Sueda

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  1. Yoshiaki Murakami
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  2. Kenichiro Uemura
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  3. Takeshi Sudo
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  4. Yasushi Hashimoto
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  5. Akira Nakashima
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  6. Naru Kondo
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  7. Ryutaro Sakabe
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  8. Hironori Kobayashi
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  9. Taijiro Sueda
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Correspondence to Yoshiaki Murakami.

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Murakami, Y., Uemura, K., Sudo, T. et al. Is Para-aortic Lymph Node Metastasis a Contraindication for Radical Resection in Biliary Carcinoma?. World J Surg 35, 1085–1093 (2011). https://doi.org/10.1007/s00268-011-1036-4

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  • DOI: https://doi.org/10.1007/s00268-011-1036-4

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