457 Background: The prognosis of intrahepatic cholangiocarcinoma (ICC) with lymph node metastases is dismal. Recent studies have highlighted the importance of lymph node retrieval from disease staging and therapeutic standpoints. To define the role of lymph node dissection for ICC, this study aimed to evaluate the patterns of lymph node metastases and their prognostic implication. Methods: A retrospective cohort analysis was conducted for 56 consecutive patients who underwent R0/R1 resection for ICC between 1990 and 2015. In principle, lymph nodes in the hepatic hilum and around the pancreas head were systematically removed. For left-sided tumors, lymph nodes in the lesser curvature of the stomach and the root of left gastric artery were also dissected. Clinicopathologic predictors of 3-year survival were identified by Cox multivariate analyses. Lymph node mapping was performed and positive nodes were classified into 3 compartments based on metastatic rates and prognoses. Results: Median tumor size, 4.5 (1.5–16.0) cm; Mass-forming and its dominant type, 42 (75%); R0 resection, 47 (84%). Nineteen (34%) patients had lymph node metastases. After excluding 4 in-hospital deaths, the overall and recurrence-free survival rates at 3 years were 66% and 33%, respectively (median follow-up, 36 months). Cox multivariate analysis revealed lymph node metastases [hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.9-21.7, P = 0.003] and R1 resection (HR 7.8, 95% CI 1.6-38.3, P = 0.01) as independent negative predictors of overall survival. Patients with ≥ 4 positive nodes ( n = 7) had significantly decreased survival compared with those with 1–3 positive nodes ( n = 10, P= 0.005). Metastatic lymph nodes were classified into compartments I (metastatic rates ≥ 10% and longest survival ≥ 3 years), II (5%–10% and 1-year survival ≥ 50%), and III ( < 5% and 1-year survival < 50%). Lymph nodes in the suprapyloric area, celiac trunk, and paraaorta belonged to compartment III and appeared less important to be dissected. Conclusions: Systematic lymph node dissection for ICC based on tumor location provides accurate staging and may prolong survival in patients with limited number of positive nodes. Compartment classification is useful to determine the extent of dissection.
The role of lymph node dissection in intrahepatic cholangiocarcinoma: a multicenter retrospective study
