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Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea–Japan Study

Authors :
Chang Moo Kang
Kyung-Suk Suh
Nam-Joon Yi
Tae Ho Hong
Sang Jae Park
Keun Soo Ahn
Hiroki Hayashi
Sae Byeol Choi
Chi-Young Jeong
Takeshi Takahara
Shigehiro Shiozaki
Young Hoon Roh
Hee Chul Yu
Takumi Fukumoto
Ryusei Matsuyama
Uyama Naoki
Kazuki Hashida
Hyung Il Seo
Takehiro Okabayashi
Tomoo Kitajima
Sohei SATOI
Hiroaki Nagano
Hongbeom Kim
Kaoru Taira
Shoji Kubo
Dong Wook Choi
Source :
Cancers, Vol 13, Iss 3, p 445 (2021)
Publication Year :
2021
Publisher :
MDPI AG, 2021.

Abstract

Background: This study was performed to investigate the oncologic role of lymph node (LN) management and to propose a surgical strategy for treating intrahepatic cholangiocarcinoma (IHCC). Methods: The medical records of patients with resected IHCC were retrospectively reviewed from multiple institutions in Korea and Japan. Short-term and long-term oncologic outcomes were analyzed according to lymph node metastasis (LNM). A nomogram to predict LNM in treating IHCC was established to propose a surgical strategy for managing IHCC. Results: A total of 1138 patients were enrolled. Of these, 413 patients underwent LN management and 725 did not. A total of 293 patients were found to have LNM. The No. 12 lymph node (36%) was the most frequent metastatic node, and the No. 8 lymph node (21%) was the second most common. LNM showed adverse long-term oncologic impact in patients with resected IHCC (14 months, 95% CI (11.4–16.6) vs. 74 months, 95% CI (57.2–90.8), p < 0.001), and the number of LNM (0, 1–3, 4≤) was also significantly related to negative oncologic impacts in patients with resected IHCC (74 months, 95% CI (57.2–90.8) vs. 19 months, 95% CI (14.4–23.6) vs. 11 months, 95% CI (8.1–13.8)), p < 0.001). Surgical retrieval of more than four (≥4) LNs could improve the survival outcome in resected IHCC with LNM (13 months, 95% CI (10.4–15.6)) vs. 30 months, 95% CI (13.1–46.9), p = 0.045). Based on preoperatively detectable parameters, a nomogram was established to predict LNM according to the tumor location. The AUC was 0.748 (95% CI: 0.706–0.788), and the Hosmer and Lemeshow goodness of fit test showed p = 0.4904. Conclusion: Case-specific surgical retrieval of more than four LNs is required in patients highly suspected to have LNM, based on a preoperative detectable parameter-based nomogram. Further prospective research is needed to validate the present surgical strategy in resected IHCC.

Details

Language :
English
ISSN :
20726694
Volume :
13
Issue :
3
Database :
Directory of Open Access Journals
Journal :
Cancers
Publication Type :
Academic Journal
Accession number :
edsdoj.51d0e0890cbd4f80b7922eed551250ea
Document Type :
article
Full Text :
https://doi.org/10.3390/cancers13030445