Clinical implication of tumor site in terms of node metastasis for intrahepatic cholangiocarcinoma

• DOI: 10.1016/j.ejso.2019.11.511
• Publication Date: 2019-11-28T18:07:03Z
• Authors: Woohyung Lee; Chi-Young Jeong; Jae Yool Jang; Young Hoon Roh; Kwan Woo Kim; Sung Hwa Kang; Myung Hee Yoon; Hyung Il Seo; Jeong-Ik Park; Bo-Hyun Jung; Dong Hoon Shin; Young Il Choi; Hyung Hwan Moon; Je Ho Ryu; Kwangho Yang; Chang Soo Choi; Yo-Han Park; Yang Won Nah; Ryounggo Kim; Jonathan Navarro; Dae-Hoon Han; Gi Hong Choi; Chang Moo Kang; Kyung-Sik Kim; Soon-Chan Hong
• Keywords: Male; Klatskin Tumor / surgery; Jejunum / surgery; Anastomosis; Cholangiocarcinoma / surgery; 610; Kaplan-Meier Estimate; Klatskin Tumor / pathology*; Disease-Free Survival; Cholangiocarcinoma; Tumor site; 03 medical and health sciences; 0302 clinical medicine; Cholangiocarcinoma / pathology*; Surgical; Hepatectomy; Humans; Proportional Hazards Models; Intrahepatic cholangiocarcinoma; Aged; Neoplasm Staging; Lymph node metastasis; Lymph Nodes / pathology*; Anastomosis, Surgical; Middle Aged; Liver / surgery; 3. Good health; Intrahepatic*; Bile Duct Neoplasms / pathology*; Bile Ducts, Intrahepatic; Jejunum; Bile Duct Neoplasms; Liver; Lymphatic Metastasis; Bile Duct Neoplasms / surgery; Lymph Node Excision; Female; Bile Ducts; Lymph Nodes; Neoplasm Grading; Klatskin Tumor

The clinical implication of lymph node (LN) dissection of intrahepatic cholangiocarcinoma (ICCA) is still controversial, and LN metastasis (LNM) based on tumor site has not been confirmed yet.Patients who underwent curative-intent surgery at 10 tertiary referral centers were identified and divided into peripheral (PP) and near second confluence level tumor (NC) groups on the basis of the distance from the second confluence and oncological outcomes were compared.Of 179 patients, 121 patients with LND were divided into the NC (n = 89) and PP groups (n = 32) on the basis of 4.5 cm from the second confluence. NC group showed higher LNM rate than PP group (46.1 vs 21.9%, p = 0.016) and NC was a risk factor for LNM (odds ratio: 4.367; 95% confidence interval: 1.234-15.453, p = 0.022). The 5-year overall survival (OS) rate (38.0% vs. 27.8%, p = 0.777) and recurrence-free survival (RFS) rates (22.8% vs. 25.8%, p = 0.742) showed no differences between the PP and NC groups. In the NC group, N1 patients showed worse 5-year OS (12.7% vs 39.0%, p = 0.004) and RFS (8.8% vs 28.6%, p = 0.004) than the N0 patients. In the PP group, discordant results in 5-year OS (48.9% vs. 50.0%, p = 0.462) and RFS (41.3% vs. 0%, p = 0.056) were found between the N0 and N1 patients.The NC group was an independent risk factor for LNM and LNM worsened prognosis in NC group for ICCA. In the PP group, LND should not be omitted because of high LNM rate and insufficient oncologic evidence.