Almost half (42.5%) of patients with intrahepatic cholangiocarcinoma (ICC) have lymph node metastasis, found a study by Chinese researchers published in the Asian Journal of Surgery. The study authors suggest that patients may need routine lymph node dissection to avoid lymph node metastasis. This, they say, can help clarify tumor staging and guide postoperative adjuvant treatment.

To explore the clinical value of lymph node dissection in ICC, a group of researchers led by Yinghe Qiu, MD, PhD, from the Department of Biliary Surgery, Third Affiliated Hospital of Naval Military Medical University in Shanghai China, collected clinical and pathological data from 147 patients with ICC. Eighty of these patients had lymph node dissection while 67 did not. Of those who did receive lymph node dissection, 34 (42.5%) were found to have lymph node metastasis.

Although lymph node dissection did not increase postoperative complications, it did increase the time of postoperative hospital stay. There was also no difference in the 5-year survival rates of patients who received lymph node dissection and those who did not.

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When the researchers analyzed the data more closely based on the stage of cancer, they found that the median survival time of patients who received lymph node resection did not improve if the cancer was in the T1 stage. However, it significantly increased in patients with cancer at the T2 to T4 stages.

The researchers reported elevated CA19-9 levels, vascular invasion, and T category were independent risk factors for poor long-term survival time in patients with ICC.

“We suggest that patients with ICC may require routine lymph node dissection, especially those with T2-4 category,” the researchers stated.

ICC is an aggressive form of liver carcinoma, the overall incidence of which is increasing globally. Surgical and adjuvant therapy have improved the overall survival rate of patients but surgery can only be performed in patients with resectable single tumors, multiple lesions, and/or hilar lymph node metastasis and is contraindicated in case of multiple tumors, extrahepatic lymph node metastasis, and distant organ metastasis. 


Yang F, Wu C, Bo Z, et al. The clinical value of regional lymphadenectomy for intrahepatic cholangiocarcinoma. Asian J Surg. Published July 30, 2021. doi:10.1016/j.asjsur.2021.06.031