Impact of regional lymph node dissection on the recurrence pattern of intrahepatic cholangiocarcinoma after radical resection

doi:10.3877/cma.j.issn.1674-0793.2022.02.002

Abstract

Abstract:

Objective

Routine regional lymph node dissection (LND) in the resection of intrahepatic cholangiocarcinoma (ICC) is still controversial. This study aims to investigate the impact of LND on the recurrence pattern of ICC after radical resection.

Methods

A total of 165 ICC patients from January 2010 to May 2021 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively selected as the research subjects. The general information, hematological examination indexes, preoperative imaging data (CT, MRI or PET-CT) and operation records of patients were collected to analyze the impact of LND on the recurrence pattern of ICC after radical resection.

Results

The sensitivity, specificity and accuracy of preoperative imaging in diagnosing lymph node metastasis were 61.0%, 58.9% and 59.4%, respectively. Among the 124 patients with cN0 complicated with LND, the proportion of positive lymph nodes in the group with dissection ≥6 accounted for 60.8% (31/51), which was significantly higher than 27.4% (20/73) in the group with dissection <6 (χ²=13.82, P<0.001). During the follow-up period, the median recurrence free survival time was 9.3 (1-49.5) months. 26 cases recurred in the group with dissection ≥6 and 40 cases in the group dissection <6, respectively. There was significant difference in the recurrence pattern between the two groups, and the recurrence rate of regional lymph nodes in the group with dissection ≥6 was lower (P=0.037).

Conclusions

The value of preoperative imaging in diagnosing lymph node metastasis in ICC is limited, and regional LND should be performed routinely. Dissection of more than 6 lymph nodes can help to improve lymph node staging and reduce local lymph node recurrence in patients with cN0 after radical resection.

Key words: Intrahepatic cholangiocarcinoma, Lymph node dissection, Lymph node metastasis, Recurrence pattern

Junbiao Guo, Shaoqiang Li, Zebing Song, Li Huang, Wenjie Hu. Impact of regional lymph node dissection on the recurrence pattern of intrahepatic cholangiocarcinoma after radical resection[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(02): 97-100.

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References 24

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临床参数		清扫个数<6	清扫个数≥6	χ²值	P值
例数		40	26
年龄(岁)				1.410	0.859
	<65	30	20
	≥65	10	6
性别				0.001	0.830
	男	22	15
	女	18	11
癌胚抗原(μg/L)				2.607	0.337
	<5	23	18
	≥5	17	8
CA19-9 (U/ml)				0.002	0.399
	<40	10	9
	≥40	30	17
乙肝表面抗原				0.443	0.630
	阴性	27	19
	阳性	13	7
血红蛋白(g/L)				<0.001	1.000
	≤130	20	13
	>130	20	13
白蛋白(g/L)				0.389	0.739
	<35	5	4
	≥35	35	22
总胆红素(μmol/L)				1.879	0.027
	≤17.1	33	15
	>17.1	7	11
谷丙转氨酶(U/L)				0.033	0.453
	<40	31	18
	≥40	9	8
谷草转氨酶(U/L)				1.605	0.453
	<40	31	18
	≥40	9	8
凝血酶原时间(s)				0.432	0.826
	<14	38	25
	≥14	2	1
肿瘤大小(cm)				0.408	0.350
	<5	11	10
	≥5	29	16
肿瘤个数				1.375	0.812
	1	25	17
	>1	15	9
出血量(ml)				0.001	0.130
	≤300	26	12
	>300	14	14
输血				0.010	0.399
	无	30	17
	有	10	9

临床参数		清扫个数<6	清扫个数≥6	χ²值	P值
例数		40	26
年龄(岁)				1.410	0.859
	<65	30	20
	≥65	10	6
性别				0.001	0.830
	男	22	15
	女	18	11
癌胚抗原(μg/L)				2.607	0.337
	<5	23	18
	≥5	17	8
CA19-9 (U/ml)				0.002	0.399
	<40	10	9
	≥40	30	17
乙肝表面抗原				0.443	0.630
	阴性	27	19
	阳性	13	7
血红蛋白(g/L)				<0.001	1.000
	≤130	20	13
	>130	20	13
白蛋白(g/L)				0.389	0.739
	<35	5	4
	≥35	35	22
总胆红素(μmol/L)				1.879	0.027
	≤17.1	33	15
	>17.1	7	11
谷丙转氨酶(U/L)				0.033	0.453
	<40	31	18
	≥40	9	8
谷草转氨酶(U/L)				1.605	0.453
	<40	31	18
	≥40	9	8
凝血酶原时间(s)				0.432	0.826
	<14	38	25
	≥14	2	1
肿瘤大小(cm)				0.408	0.350
	<5	11	10
	≥5	29	16
肿瘤个数				1.375	0.812
	1	25	17
	>1	15	9
出血量(ml)				0.001	0.130
	≤300	26	12
	>300	14	14
输血				0.010	0.399
	无	30	17
	有	10	9

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