Routine and radical lymph node dissection is a clinical concern for improving the surgical outcome in patients with intrahepatic cholangiocarcinoma (ICC). The therapeutic value of the procedure during hepatectomy has, however, not been evaluated.
Between January 1990 and December 2004, 104 patients with ICC undergoing macroscopic curative resections were investigated retrospectively with special reference to lymph node status. The role of lymph node dissection was evaluated according to macroscopic type: mass-forming (MF) type (n = 68) and MF plus periductal infiltration (PI) type (n = 36) of ICC.
Lymph node involvement and intrahepatic metastases were an independent, unfavorable prognostic factor in the MF type of ICC. Negative lymph node involvement provided a favorable survival rate in the 41 patients without intrahepatic metastases (P < .0001). Among the 29 patients without lymph node involvement and intrahepatic metastases, there was no difference according to the use of lymph node dissection (P = .8071). Also, no difference was seen with lymph node involvement in the 24 patients with the MF plus PI type of ICC who had no intrahepatic metastases (P = .6620).
For purpose of diagnostic staging and exclusion of positive regional lymph nodes, lymph node dissections might be useful in patients with the MF type and the MF plus PI type of ICC; however, routine use of lymph node dissection in patients with the MF type of ICC is not recommended, because no difference in survival was observed in the patients with negative lymph node metastases, irrespective of the use of lymph node dissection.
"Despite this, some investigators have argued that routine lymphadenectomy is unnecessary. For example, in a report on 68 patients with mass-forming iCCA, 36 of who underwent concomitant lymphadenectomy , the authors reported that among those patients without lymph node involvement, there was no difference in survival or pattern of recurrence according to the use of lymph node dissection. The authors concluded that routine lymphadenectomy was not necessary in patients with mass-forming iCCA when lymph node involvement is not clinically apparent. "
"Lymph node metastasis is known as one of the important prognostic factors for survival in patients with ICC, and lymph node recurrence after surgery is one of the most intractable situations in patients with ICC.20,21,24–27 In the present study, lymph node metastasis tended to be lower in the CoCC group than in the ICC group. "
[Show abstract][Hide abstract] ABSTRACT: Cholangiolocellular carcinoma (CoCC) has distinct pathological characteristics, and CoCC is considered to originate from hepatic progenitor or stem cells. However, the surgical outcome of CoCC has not been clarified in detail.
We retrospectively studied 275 patients with intrahepatic cholangiocarcinoma (ICC) who underwent hepatectomy between 1990 and 2011. Surgical outcomes were compared between 29 patients with CoCC and 130 patients with mass-forming (MF) type ICC since all patients with CoCC showed MF type on macroscopic findings.
The number of patients with chronic liver disease was significantly higher in the CoCC group than in the ICC group. The number of patients with abnormal levels of CA19-9 was significantly lower in the CoCC group than in the ICC group. Portal vein invasion and intrahepatic metastasis were significantly lower in patients with CoCC group than in the ICC group. In the CoCC group, 15 of 28 patients survived for more than 5 years after curative surgery whereas 15 of 102 patients with ICC survived for more than 5 years after curative surgery. The 5-year survival rate was significantly higher in patients with CoCC (75 %) than in patients with ICC (33 %, p = 0.0005). Multivariate analysis showed CoCC, absence of portal vein invasion or hepatic vein invasion, and absence of intrahepatic metastasis to be significant independent prognostic factors for overall survival in patients with MF-type ICC and CoCC.
CoCC is rare, but patients with CoCC had special characteristics with favorable long-term survival due to its less invasive histopathologic characteristics.
[Show abstract][Hide abstract] ABSTRACT: Die chirurgische Therapie von primären und sekundären hepatobiliären Tumoren, wie z.B. kolorektalen Lebermetastasen, hepatozellulären
Karzinomen, cholangiozellulären Karzinomen und Gallenblasenkarzinomen, stellt bis heute die einzige potenziell kurative Therapiemöglichkeit
dar. Ziel der chirurgischen Therapie ist stets die R0-Resektion des Tumors. Nach derzeitiger Datenlage stellt das Ausmaß des
Lymphknotenbefalls einen wichtigen prognostischen Parameter bei hepatobiliären Tumoren dar. Indikation und Ausmaß der Lymphknotendissektion
in der hepatobiliären Chirurgie ist Gegenstand der Diskussion. Es konnte bisher nicht eindeutig nachgewiesen werden, dass
das Gesamtüberleben bei Patienten mit hepatobiliären Tumoren und Lymphknotenmetastasen durch eine systematische Lymphknotendissektion
gesenkt wird. Randomisierte, prospektive Studien zu diesem Thema fehlen jedoch nahezu vollständig. Eine lokoregionäre Lymphknotendissektion
(Ligamentum hepatoduodenale, retropankreatoduodenale Lymphknoten) kann jedoch mit niedriger Mortalität und Morbidität durchgeführt
werden und erscheint häufig schon alleine für das Staging sinnvoll. Weitere randomisierte Studien sind dringend erforderlich,
um den Stellenwert der Lymphknotendissektion zu definieren.
Surgical R0 resection of primary and secondary hepatobiliary tumors, such as colorectal liver metastases, hepatocellular carcinoma,
cholangiocellular carcinoma and gall bladder carcinoma, remains the only potentially curative treatment option. The extent
of involvement of lymph node metastases seems to be an independent prognostic factor in these tumors. The prognostic value
of a systematic lymph node dissection in hepatobiliary tumors still remains unclear as there is a lack of prospective randomized
trials. However, local lymphadenectomy (hepatoduodenal ligament and retropancreaticoduodenal lymph nodes) can be easily performed
with low mortality and morbidity rates and may be helpful in better staging of the patients. Further randomized trials are
necessary in order to define the relevance of lymph node dissection in hepatobiliary surgery
Der Chirurg 02/2010; 81(2):111-116. DOI:10.1007/s00104-009-1812-y · 0.57 Impact Factor
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