title: Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution.
abstract: BACKGROUND
  Although use of lymphadenectomy for treatment of extrahepatic cholangiocarcinoma is established, routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) remains controversial. We examined the factors predicting survival in patients after ICC resection and compared outcomes of patients with and without systematic hepatic pedicle lymph node dissection (LND).
  
  
  METHODS
  Data were retrospectively collected for 215 patients with ICC who underwent liver resection during the years 1995-2012. Patients were divided into those (n = 102; 47.4%) who received LND (LN [D]) and those (n = 113; 52.6%) who did not (LN [D0]).
  
  
  RESULTS
  Demographic data were similar between the 2 groups except for presence of preoperative symptom (P = .019) and liver cirrhosis (P < .001), carbohydrate antigen 19-9 (P = .003), tumor location according to the hepatic lobe (P < .001), type of hepatectomy (P < .001), adjuvant treatment (P < .001), and postoperative complications (P = .028). Tumor recurrence at a distant site was observed in 102 patients (68.5%). LN metastasis was independently associated with risk of distant recurrence (P = .002). The LN (D) and LN (D0) groups did not differ in overall survival (P = .101) or disease-free survival (P = .111). Poorly differentiated histologic grade (P = .016) and LN metastasis (P < .001) was identified as an independent predictor of overall survival.
  
  
  CONCLUSIONS
  Routine LND for ICC did not show survival benefits; however, LN sampling might be useful for nodal staging, an essential factor in predicting outcome and deciding whether to apply adjuvant treatment.
authors: Department of Surgery, Dankook University Hospital, Cheonan, Republic of Korea.
authors: Dong Hun
authors: DH
authors: Kim
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: dwchoi@skku.edu.
authors: Dong Wook
authors: DW
authors: Choi
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Seong Ho
authors: SH
authors: Choi
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jin Seok
authors: JS
authors: Heo
authors: Department of Hepatopancreatobiliary and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore.
authors: Alfred Wei-Chieh
authors: AW
authors: Kow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome