Patients with clinically node-negative (cN0) intrahepatic cholangiocarcinoma (CCA) undergoing liver resection could benefit from adequate lymphadenectomy (LND), according to a recently published study in the Journal of Hepatology.

Surgical liver resection is currently the only curative treatment for CCA. Unfortunately, over 50% of patients that undergo surgery will experience tumor recurrence, Carlo Spositol, MD, of the University of Milan in Italy, noted.

It is clear that lymph node metastasis is among the most important predictive factors for poor outcomes after surgical resection, the researchers said. However, performing LND in patients with no evidence of lymph node metastasis remains a controversial practice, the authors added.

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“This is partly due to the inconsistent reports in support of its clinical benefit, with no solid evidence of its impact on long-term survival, and to concerns on the increased risk of complications related to extended LND,” the authors wrote.

The authors aimed to determine if adequate LND has a significant effect on the long-term survival of patients with CCA that undergo surgical liver resection. The retrospective cohort study included over 700 patients who underwent surgery in 5 different centers between 2000 and 2020. Adequate LND was defined as the excision of at least 6 lymph nodes during surgery; anything less was defined as inadequate LND.

Cox regression and Kaplan Meier curves were used to compare overall survival and recurrence-free survival between patients that received adequate LND and those that received inadequate LND. 

Among the included population, approximately 60% received adequate LND. Over 40% of patients receiving adequate LND had positive lymph nodes, compared to 14% in the inadequate LND group, which represented a 3-fold increase in the odds of detecting positive lymph nodes. Patients who underwent adequate LND had a higher incidence of postoperative complications. 

The authors noted that patients that received adequate LND had worse prognostic factors before surgery, such as larger tumor size, higher carcinoembryonic antigen levels, and worse tumor grading. 

During the 33-month median follow-up period, the average overall survival was 39 months, and the recurrence-free survival was 23 months. Patients that underwent adequate LND had a longer median recurrence-free survival than those who did not (24 months vs 18 months) and a longer median overall survival (42 months vs 35 months) after inverse probability of treatment weighting adjustment.

A deeper analysis revealed that the benefit of adequate LND was more significant in patients that did not suffer from chronic liver disease, had smaller tumors, and had no evidence of macrovascular invasion.

“The results of this study empower surgeons and clinicians in claiming an adequate lymphadenectomy even in cN0 patients,” the authors concluded.


Sposito C, Ratti F, Cucchetti A, et al. Survival benefit of adequate lymphadenectomy in patients undergoing liver resection for clinically node negative intrahepatic cholangiocarcinoma. J Hepat. Published online October 21, 2022. doi:10.1016/j.jhep.2022.10.021