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British Journal of Surgery
Article . 2018 . Peer-reviewed
License: OUP Standard Publication Reuse
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Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma

Authors: X -F Zhang; J Chakedis; F Bagante; Q Chen; E W Beal; Y Lv; M Weiss; +14 Authors

Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma

Abstract

Abstract Background The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC. Methods Patients undergoing curative intent resection for ICC in 2000–2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories. Results Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM. Conclusion The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.

Countries
Portugal, Italy, Netherlands
Keywords

Male, Databases, Factual, EMC MM-04-47-07, Cholangiocarcinoma, Bile Duct Neoplasms / surgery*, Hepatectomy, Humans, Bile Duct Neoplasms / classification, Aged, Neoplasm Staging, Middle Aged, HCC CIR, Lymph Node Excision / statistics & numerical data*, Cholangiocarcinoma / classification, Bile Duct Neoplasms / pathology, Cholangiocarcinoma / pathology, Bile Duct Neoplasms, lymphadenectomy; intrahepatic cholangiocarcinoma, Lymphatic Metastasis, Lymph Node Excision, Female, Cholangiocarcinoma / surgery*

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selected citations
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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