The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival

Ann Surg Oncol. 2009 Nov;16(11):3048-56. doi: 10.1245/s10434-009-0631-1. Epub 2009 Jul 22.

Abstract

Background: Surgical resection has been shown to improve long-term survival for patients with intrahepatic cholangiocarcinoma (ICC). The benefit of lymph node dissection is still controversial. The aims of this study were to investigate the prognostic factors of ICC and to examine the impact of lymph node metastasis and extent of lymph node dissection on survival.

Materials and methods: A total of 64 patients with ICC were operated on with curative intent and resultant macroscopic curative resection (R0 and R1). The patients were classified according to the extent of the lymph node dissection. Clinicopathological characteristics and survival were reviewed retrospectively.

Results: All patients underwent anatomical resection. The 5-year survival rates were 39.5%. Multivariate analysis revealed that lymph node metastasis (hazard ratio: 3.317) was an independent prognostic factors on survival. Recurrence occurred in 41 patients. Median disease-free survival time was 12.3 months. Tumor differentiation was an independent prognostic factor for disease-free survival (hazard ratio: 3.158). The extent of lymph node dissection did not affect the occurrence of complication. Regional+alpha lymph node dissection group demonstrated similar survival to those of lymph node sampling group, although significant high incidence of lymph node metastases was observed in the regional+alpha lymph node dissection group. The extent of lymph node dissection did not affect the survival in the patients without lymph node involvement.

Conclusions: The regional+alpha lymph node dissection enhanced the survival in the ICC patients with lymph node metastasis, and the exact nodal status could be confirmed by lymph node dissection in the pericholedochal lymph nodes.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / mortality*
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Intrahepatic / pathology
  • Bile Ducts, Intrahepatic / surgery*
  • Cholangiocarcinoma / mortality*
  • Cholangiocarcinoma / secondary
  • Cholangiocarcinoma / surgery
  • Female
  • Humans
  • Laparotomy
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome