title: Clinical impact of lymph node dissection in surgery for peripheral-type intrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  To investigate the prognostic factors of peripheral-type intrahepatic cholangiocarcinoma (PP-IHCC) and evaluate the surgical outcomes according to surgical strategy alterations.
  
  
  METHODS
  Twenty-two patients were divided into two groups according to the surgical strategy: an extended surgery group (Ex group: n = 10), composed of those who underwent hepatic lobectomy combined with lymph node (LN) dissection and bile duct resection; and a customized surgery group (Cx group: n = 12), composed of those who underwent hepatectomy and bile duct resection according to tumor spread. LN dissection was not performed in patients without LN metastasis.
  
  
  RESULTS
  Multivariate analysis revealed that R2 resection, LN metastasis, and intrahepatic metastasis were independent prognostic factors. LN dissection was significantly infrequent in the Cx group. Survival after curative resection was similar in the two groups (3-year survival: 42.9 vs. 57.1%). Liver metastasis was the most frequent primary recurrence, occurring in more than 80% of patients from both groups.
  
  
  CONCLUSIONS
  Curative surgery might improve the prognosis of patients with PP-IHCC, but routine LN dissection is not recommended, particularly for patients without LN metastasis. Surgery alone, including LN dissection, cannot control this type of tumor, and additional treatment should be given.
authors: Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. ymorine@clin.med.tokushima-u.ac.jp
authors: Yuji
authors: Y
authors: Morine
authors: Mitsuo
authors: M
authors: Shimada
authors: Tohru
authors: T
authors: Utsunomiya
authors: Satoru
authors: S
authors: Imura
authors: Tetsuya
authors: T
authors: Ikemoto
authors: Hiroki
authors: H
authors: Mori
authors: Jun
authors: J
authors: Hanaoka
authors: Mami
authors: M
authors: Kanamoto
authors: Hidenori
authors: H
authors: Miyake
mesh_terms: D000005:Abdomen; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome