title: Is para-aortic lymph node metastasis a contraindication for radical resection in biliary carcinoma?
abstract: BACKGROUND
  Para-aortic nodal dissection in patients with biliary carcinoma has not been performed routinely worldwide. Therefore, the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma has not yet been evaluated. The aim of this study was to clarify the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma.
  
  
  METHODS
  Of 113 patients with biliary adenocarcinoma who underwent surgical resection with regional and para-aortic lymph node dissection, para-aortic lymph node metastasis was found in 17 patients (15%) by final pathological examination. Relationships between clinicopathological factors, including para-aortic lymph node metastasis, and survival were analyzed by univariate and multivariate analyses.
  
  
  RESULTS
  Overall survival rates for the 113 patients were 82% at 1 year, 65% at 2 years, 58% at 3 years, and 52% at 5 years. Univariate analysis revealed that better tumor differentiation (P=0.044), negative lymph node metastasis (P<0.001), negative para-aortic lymph node metastasis (P=0.007), negative surgical margin status (P<0.001), lower UICC pT factor (P=0.009), and earlier UICC stage (P<0.001) were associated significantly with longer survival. Lymph node metastasis (P=0.004) but not para-aortic lymph node metastasis (P=0.323) remained associated independently with longer survival by multivariate analysis. Five-year survival rates for node-negative patients, node-positive patients without para-aortic lymph node metastasis, and node-positive patients with para-aortic lymph node metastasis were 72, 31, and 24%, respectively.
  
  
  CONCLUSIONS
  Radical resection should not be abandoned for patients with para-aortic lymph node metastasis in biliary adenocarcinoma.
authors.affiliation: Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. mura777@hiroshima-u.ac.jp
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sudo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Nakashima
authors.forename: Naru
authors.initials: N
authors.lastname: Kondo
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Sakabe
authors.forename: Hironori
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001011:Aorta / Q000473:pathology; D001661:Biliary Tract Neoplasms / Q000473:pathology* / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis