title: Intrahepatic Cholangiocarcinoma: Prognosis of Patients Who Did Not Undergo Lymphadenectomy.
abstract: BACKGROUND
  The role of routine lymphadenectomy (LD) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) remains poorly defined. This study aimed to evaluate the role of routine LD as well as to quantify the impact of not assessing nodal station on disease-specific survival (DSS) among patients undergoing liver surgery for ICC.
  
  
  METHODS
  Using data from 12 major hepatobiliary centers, 561 patients undergoing liver surgery for ICC between 1990 and 2012 were identified. The association between nodal status and DSS was assessed using Cox proportional and Aalen's linear hazards models.
  
  
  RESULTS
  Among the 272 (48.5%) patients who underwent LD, 123 (45.2%) had lymph node metastasis (N1). Although differences in DSS were noted between N0 and Nx patients within the first 18 months after surgery (DSS at 18 months: N0 vs Nx, 70.2% vs 60.6%, respectively, p = 0.019) among patients who had survived to 18 months, the DSS at 60 months of Nx patients was comparable to that of N0 patients (p = 0.48). Conversely, although the DSS of N1 and Nx patients was comparable in the short-term (DSS at 18 months: p = 0.13), among patients who had survived to 18 months, N1 patients had a lower DSS compared with Nx patients (DSS at 60 months among patients who had survived to 18 months: N1 vs Nx, 15.2% vs 45.8%, respectively, p < 0.001; all p values were based on the log-rank test comparing 2 survival curves).
  
  
  CONCLUSIONS
  Although Nx patients and N1 patients had comparable DSS in the short-term, Nx patients who survived past 18 months had a survival comparable to that of N0 patients. Lack of nodal staging may lead to heterogeneous and potentially incorrect prognostic classification of patients with ICC.
authors.affiliation: the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bagante
authors.affiliation: the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.affiliation: Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Sorin
authors.initials: S
authors.lastname: Alexandrescu
authors.affiliation: Curry Cabral Hospital, Lisbon, Portugal.
authors.forename: Hugo P
authors.initials: HP
authors.lastname: Marques
authors.affiliation: Curry Cabral Hospital, Lisbon, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Lamelas
authors.affiliation: Ospedale San Raffaele, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: University of Sydney, Sydney, Australia.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
authors.affiliation: University of Virginia, Charlottesville, VA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
authors.affiliation: Stanford University, Stanford, CA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis