Routine lymph node dissection may be not suitable for all intrahepatic cholangiocarcinoma patients: Results of a monocentric series

Table 1 Operative procedures for intrahepatic cholangiocarcinoma

Operative modality	n
Hepatic resection (n = 124)
Major resection (n = 65)
Partial hepatectomy	38
Right trisectionectomy	1
Left trisectionectomy	2
Extended left hemihepatectomy	2
Right hemihepatectomy	4
Left hemihepatectomy	15
Central bisectionectomy	3
Minor resection (n = 59)
Partial hepatectomy	37
Right anterior sectionectomy	4
Right posterior sectionectomy	3
Left lateral sectionectomy	8
Bisegmentectomy	7
Additional procedures (n = 67)
Spleen resection	2
Gallbladder resection	12
Lymph node dissection	53

Table 2 Clinicopathologic characteristics of patients in the lymph node dissection (-) and lymph node dissection (+) lymph node (-) groups

Factor	LND (-)	LND (+) LN (-)	P value
	n = 61	n = 42
Gender			1.000
Female	13	9
Male	48	33
Age			0.516
≤ 60	44	27
> 60	17	15
Viral hepatitis			1.000
Yes	36	24
No	25	18
Cirrhosis			0.694
Yes	28	21
No	33	21
Child-Pugh class			0.735
A	55	39
B	6	3
CA19-9 (U/mL)			0.553
≤ 37	30	18
> 37	31	24
Histologic differentiation			0.498
Well or Moderate	44	33
Poor	17	9
Gross type			0.433
MF	43	28
PI	4	7
IG	5	2
MF + PI	5	4
MF + IG	4	1
Tumor number			0.510
Single	45	28
Multiple	16	14
Tumor size (cm)			0.318
< 5	33	18
≥ 5	28	24
TNM classification			0.080
Early (stage I, II)	47	25
Advanced (stage III, IV)	14	17
Width of resection margin (cm)			0.229
< 1	33	17
≥ 1	28	25
Surgical procedure			0.153
Major hepatectomy	41	22
Minor hepatectomy	20	20

CA19-9: Carbohydrate antigen 19-9; IG: Intraductal growth; LN: Lymph node; LND: Lymph node dissection; MF: Mass-forming; PI: Periductal infiltrating; TNM: Tumor-node-metastasis.

Table 3 Sites of initial recurrence in intrahepatic cholangiocarcinoma patients after resection with curative intent

Site of initial recurrence	LND (-)	LND(+) LN (-)	LND(+) LN (+)
	n = 61	n = 42	n = 11
Liver, lymph nodes	6	3	2
Liver, lung	2	0	1
Liver	25	18	6
Lymph nodes	3	1	0
Peritoneum	5	2	2
Wound site	0	1	0
Bone	0	1	0
Lung	1	1	0
Total No. of recurrence	42	27	11

LN: Lymph node; LND: Lymph node dissection.

Table 4 Selected published series of intrahepatic cholangiocarcinoma patients after resection

Author	Year	Cases	Prognostic factors	Median survival time	5-yr survival rate	Routine LND
Ribero et al[8]	2012	434	LN metastases	33	32.90%	No
			Multiple tumors
			CA19.9 level
de Jong et al[9]	2011	449	Tumor number	27.3	30.7	No
			Vascular invasion
			LN metastasis
Saxena et al[26]	2010	88	CA 19.9 level	33	28	No
			Clinical stage
			Histological grade
			LN metastases
Ercolani et al[27]	2010	72	LN metastasis	57.1	48	Yes
			Blood transfusion
Cho et al[28]	2010	63	Old age	Not available	31.8	Yes
			CA19-9 level
			LN metastasis
			Narrow resection margin
Shirabe et al[29]	2010	60	Lymphatic invasion index	Not available	30.6	No
			Histological grade
Guglielmi et al[30]	2009	81	LN metastasis	40	20	Not available
			Vascular invasion
Tamandl et al[31]	2009	93	Lymph node ratio	25.5	Not available	No
Choi et al[37]	2009	64	LN metastasis	39	39.5	No
Shimada et al[32]	2009	104	Intrahepatic metastases	25	37	No
			LN metastasis
Yedibela et al[33]	2009	67	Resection margin	26	27	No
			LN metastasis
			Blood transfusion
Nakagohri et al[34]	2008	56	Intrahepatic metastasis	22	32	Not available
Uenishi et al[35]	2008	133	Intrahepatic metastasis	18.4	29	Yes
			LN metastases
			Tumor at the margin
Shimada et al[36]	2007	57	LN metastasis	62	56.8	No

LN: Lymph node; LND: Lymph node dissection; ICC: Intrahepatic cholangiocarcinoma.