Lymph node dissection (LND), or lymphadenectomy, has recently been shown to improve outcomes in patients with certain forms of intrahepatic cholangiocarcinoma (ICC).
Patients who underwent LND had improved 1-, 3-, and 5-year survival rates (83.5%, 52.2%, and 42.8%, respectively), compared to those who did not receive LND, whose survival rates were of 1.9%, 32.4%, and 23.4%, respectively (P =.046), according to a study published in the Journal of Hepato-Biliary Pancreatic Sciences. LND also showed an increased prognostic impact (hazard ratio [HR] =.58, P =.005).
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These findings were reached after adjustment for imbalances in tumor advancement between groups using inverse probability of treatment weighting (IPTW). This procedure was necessary to adjust for more advanced tumors seen in the patients who received LND, including greater tumor size (P =.002), a higher frequency of multinodal tumors (P =.010), and higher serosal invasion (P =.020).
Without adjustment, the 1-, 3-, and 5-year survival rates were comparable between patients who received LND and patients who did not receive LND (81.6% vs 81.6%, 48.0% vs 55.4%, and 37.5% vs 44.6%, respectively; P =.747).
Upon subgroup analysis based on tumor localization, the increased survival after LND appeared to only occur in patients with hilar ICC (HR =.45, P =.011). A significant improvement with LND was not seen in patients with peripheral ICC (peripheral left side HR =.86, P =.729; peripheral right side HR =.52, P =.089).
“In addition to the essential role of LND for accurate staging to assist in decision-making regarding adjuvant therapy, LND could have therapeutic benefits in improving patient survival. In particular, hilar ICC should be treated with extensive surgery and adequately systemized LND to achieve curative resection,” the authors concluded, based on the study’s results.
In the study, a total of 224 patients received LND compared to 86 patients who did not. Out of 224 patients who received LND, 90 (40%) were confirmed to have lymph node metastasis and 182 received extended LND beyond the hepatoduodenal ligament.
Umeda Y, Mitsuhashi T, Kojima T, et al. Impact of lymph node dissection on clinical outcomes of intrahepatic cholangiocarcinoma: inverse probability of treatment weighting with survival analysis. J Hepatobiliary Pancreat Sci. Published online September 2, 2021. doi:10.1002/jhbp.1038