• Fabio Bagante, Faiz Gani, Gaya Spolverato, Li Xu, Sorin Alexandrescu, Hugo P Marques, Jorge Lamelas, Luca Aldrighetti, T Clark Gamblin, Shishir K Maithel, Carlo Pulitano, Todd W Bauer, Feng Shen, George A Poultsides, MarshJ WallisJWUniversity of Pittsburgh Medical Center, Pittsburgh, PA., and Timothy M Pawlik.
• the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
• J. Am. Coll. Surg. 2015 Dec 1; 221 (6): 1031-40.e1-4.

BackgroundThe role of routine lymphadenectomy (LD) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) remains poorly defined. This study aimed to evaluate the role of routine LD as well as to quantify the impact of not assessing nodal station on disease-specific survival (DSS) among patients undergoing liver surgery for ICC.Study DesignUsing data from 12 major hepatobiliary centers, 561 patients undergoing liver surgery for ICC between 1990 and 2012 were identified. The association between nodal status and DSS was assessed using Cox proportional and Aalen's linear hazards models.ResultsAmong the 272 (48.5%) patients who underwent LD, 123 (45.2%) had lymph node metastasis (N1). Although differences in DSS were noted between N0 and Nx patients within the first 18 months after surgery (DSS at 18 months: N0 vs Nx, 70.2% vs 60.6%, respectively, p = 0.019) among patients who had survived to 18 months, the DSS at 60 months of Nx patients was comparable to that of N0 patients (p = 0.48). Conversely, although the DSS of N1 and Nx patients was comparable in the short-term (DSS at 18 months: p = 0.13), among patients who had survived to 18 months, N1 patients had a lower DSS compared with Nx patients (DSS at 60 months among patients who had survived to 18 months: N1 vs Nx, 15.2% vs 45.8%, respectively, p < 0.001; all p values were based on the log-rank test comparing 2 survival curves).ConclusionsAlthough Nx patients and N1 patients had comparable DSS in the short-term, Nx patients who survived past 18 months had a survival comparable to that of N0 patients. Lack of nodal staging may lead to heterogeneous and potentially incorrect prognostic classification of patients with ICC.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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