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Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea-Japan Study

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Author(s)
Chang Moo KangKyung-Suk SuhNam-Joon YiTae Ho HongSang Jae ParkKeun Soo AhnHiroki HayashiSae Byeol ChoiChi-Young JeongTakeshi TakaharaShigehiro ShiozakiYoung Hoon RohHee Chul YuTakumi FukumotoRyusei MatsuyamaUyama NaokiKazuki HashidaHyung Il SeoTakehiro OkabayashiTomoo KitajimaSohei SATOIHiroaki NaganoHongbeom KimKaoru TairaShoji KuboDong Wook Choi
Keimyung Author(s)
Ahn, Keun Soo
Department
Dept. of Surgery (외과학)
Journal Title
Cancers (Basel)
Issued Date
2021
Volume
13
Issue
3
Keyword
cholangiocarcinomalymph nodesmetastasisnomograms
Abstract
Background:
This study was performed to investigate the oncologic role of lymph node (LN) management and to propose a surgical strategy for treating intrahepatic cholangiocarcinoma (IHCC).

Methods:
The medical records of patients with resected IHCC were retrospectively reviewed from multiple institutions in Korea and Japan. Short-term and long-term oncologic outcomes were analyzed according to lymph node metastasis (LNM). A nomogram to predict LNM in treating IHCC was established to propose a surgical strategy for managing IHCC.

Results:
A total of 1138 patients were enrolled. Of these, 413 patients underwent LN management and 725 did not. A total of 293 patients were found to have LNM. The No. 12 lymph node (36%) was the most frequent metastatic node, and the No. 8 lymph node (21%) was the second most common. LNM showed adverse long-term oncologic impact in patients with resected IHCC (14 months, 95% CI (11.4–16.6) vs. 74 months, 95% CI (57.2–90.8), p < 0.001), and the number of LNM (0, 1–3, 4≤) was also significantly related to negative oncologic impacts in patients with resected IHCC (74 months, 95% CI (57.2–90.8) vs. 19 months, 95% CI (14.4–23.6) vs. 11 months, 95% CI (8.1–13.8)), p < 0.001). Surgical retrieval of more than four (≥4) LNs could improve the survival outcome in resected IHCC with LNM (13 months, 95% CI (10.4–15.6)) vs. 30 months, 95% CI (13.1–46.9), p = 0.045). Based on preoperatively detectable parameters, a nomogram was established to predict LNM according to the tumor location. The AUC was 0.748 (95% CI: 0.706–0.788), and the Hosmer and Lemeshow goodness of fit test showed p = 0.4904.

Conclusion:
Case-specific surgical retrieval of more than four LNs is required in patients highly suspected to have LNM, based on a preoperative detectable parameter-based nomogram. Further prospective research is needed to validate the present surgical strategy in resected IHCC.
Keimyung Author(s)(Kor)
안근수
Publisher
School of Medicine (의과대학)
Citation
Chang Moo Kang et al. (2021). Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea-Japan Study. Cancers (Basel), 13(3), 445. doi: 10.3390/cancers13030445
Type
Article
ISSN
2072-6694
Source
https://www.mdpi.com/2072-6694/13/3/445
DOI
10.3390/cancers13030445
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43587
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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