Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma.
BACKGROUND
Hepatectomy with extensive lymph node dissection is the standard operation for intrahepatic cholangiocarcinoma (IHCC). However, lymph node dissection may not always be effective at reducing tumour recurrence.


METHODS
Forty-nine patients with IHCC who underwent hepatectomy were investigated to determine patterns of tumour recurrence and to estimate the value of lymph node dissection during resection.


RESULTS
At hepatectomy most metastatic lymph nodes were identified at least to the level of group 2 lymph nodes. Among 23 patients who developed recurrence, 17 had liver metastases and the other six had recurrence at other sites, mainly in the peritoneum. Poorly differentiated histology was related to the development of liver metastases. No patient with the intraductal growth type of IHCC had tumour recurrence. Lymph node dissection did not appear to improve patient survival. Histological findings of lymph node metastases and intrahepatic metastases were independent indicators of poor prognosis.


CONCLUSIONS
Lymph node metastases were seldom limited to the regional lymph nodes; most tumour recurrence occurred in the liver. Lymph node dissection did not appear to improve patient survival. Lymph node dissection alone is not likely to improve the prognosis without further control of liver metastases.
Shimada
M
M
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-0046, Japan. mshimada@surg2.med.kyushu-u.ac.jp
Yamashita
Y
Y
Aishima
S
S
Shirabe
K
K
Takenaka
K
K
Sugimachi
K
K
D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018395:CA-19-9 Antigen / Q000032:analysis; D018281:Cholangiocarcinoma / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016019:Survival Analysis
D018395:CA-19-9 Antigen