Benefit of lymph node dissection for perihilar and distal cholangiocarcinoma according to lymph node stations.
distal cholangiocarcinoma
lymph node dissection
lymph node station
perihilar cholangiocarcinoma
regional lymph nodes
Journal
Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Titre abrégé: J Hepatobiliary Pancreat Sci
Pays: Japan
ID NLM: 101528587
Informations de publication
Date de publication:
25 Oct 2023
25 Oct 2023
Historique:
revised:
03
09
2023
received:
10
07
2023
accepted:
18
09
2023
medline:
25
10
2023
pubmed:
25
10
2023
entrez:
25
10
2023
Statut:
aheadofprint
Résumé
The benefits of lymph node (LN) dissection at each station have not previously been fully investigated in perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC). The efficacy index (EI) was calculated in patients who underwent surgery for PHCC (n = 134) and DCC (n = 135) by multiplying the frequency of metastasis to the LN station and the 5-year overall survival (OS) rate of patients with metastasis to that station. In PHCC, the frequency of metastasis, 5-year OS rates, and the EI in para-aortic LNs (4.7%, 0%, and 0, respectively) and posterior pancreaticoduodenal LNs (8.1%, 0%, and 0, respectively) were lower than those in hepatoduodenal ligament LNs (30.1%, 24.1%, and 7.25, respectively) and LNs along the common hepatic artery (CHA) (16.2%, 15.0%, and 2.43, respectively). In DCC, these values were lower in LNs along the CHA (6.4%, 0%, and 0, respectively) than in the posterior pancreaticoduodenal LNs (31.2%, 34.5%, and 10.8, respectively), the hepatoduodenal ligament LNs (14.8%, 15.2%, and 2.25, respectively), and para-aortic (4.0%, 25.0%, and 0.99, respectively) LNs. According to the EI, this study raises concerns about the effectiveness of dissection in the posterior pancreaticoduodenal LNs in PHCC and LNs along the CHA in DCC.
Sections du résumé
BACKGROUND
BACKGROUND
The benefits of lymph node (LN) dissection at each station have not previously been fully investigated in perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC).
METHODS
METHODS
The efficacy index (EI) was calculated in patients who underwent surgery for PHCC (n = 134) and DCC (n = 135) by multiplying the frequency of metastasis to the LN station and the 5-year overall survival (OS) rate of patients with metastasis to that station.
RESULTS
RESULTS
In PHCC, the frequency of metastasis, 5-year OS rates, and the EI in para-aortic LNs (4.7%, 0%, and 0, respectively) and posterior pancreaticoduodenal LNs (8.1%, 0%, and 0, respectively) were lower than those in hepatoduodenal ligament LNs (30.1%, 24.1%, and 7.25, respectively) and LNs along the common hepatic artery (CHA) (16.2%, 15.0%, and 2.43, respectively). In DCC, these values were lower in LNs along the CHA (6.4%, 0%, and 0, respectively) than in the posterior pancreaticoduodenal LNs (31.2%, 34.5%, and 10.8, respectively), the hepatoduodenal ligament LNs (14.8%, 15.2%, and 2.25, respectively), and para-aortic (4.0%, 25.0%, and 0.99, respectively) LNs.
CONCLUSIONS
CONCLUSIONS
According to the EI, this study raises concerns about the effectiveness of dissection in the posterior pancreaticoduodenal LNs in PHCC and LNs along the CHA in DCC.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Références
Mantel HT, Wiggers JK, Verheij J, Doff JJ, Sieders E, van Gulik TM, et al. Lymph node micrometastases are associated with worse survival in patients with otherwise node-negative hilar cholangiocarcinoma. Ann Surg Oncol. 2015;22(Suppl 3):S1107-S1115.
Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T. Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg. 2007;31:337-342; discussion 43-4.
Ito K, Ito H, Allen PJ, Gonen M, Klimstra D, D'Angelica MI, et al. Adequate lymph node assessment for extrahepatic bile duct adenocarcinoma. Ann Surg. 2010;251:675-681.
Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC): TNM classification of malignant Tumours. 8th ed. Oxford: Wiley-Blackwell; 2017.
Sakata J, Wakai T, Matsuda Y, Ohashi T, Hirose Y, Ichikawa H, et al. Comparison of number versus ratio of positive lymph nodes in the assessment of lymph node status in extrahepatic cholangiocarcinoma. Ann Surg Oncol. 2016;23:225-234.
Wu R, Zhang G, Feng J, Zhang L, Yang Z. Proposal of the optimal numbers of examined and positive lymph nodes to the 8th edition of American Joint Committee on Cancer (AJCC) staging for 758 patients with distal cholangiocarcinoma. PLoS One. 2020;15:e0234464.
Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Conci S, Valdegamberi A, et al. Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma. HPB (Oxford). 2011;13:240-245.
Conci S, Ruzzenente A, Sandri M, Bertuzzo F, Campagnaro T, Bagante F, et al. What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes. Eur J Surg Oncol. 2017;43:743-750.
Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82:346-351.
Imamura T, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, et al. Reconsidering the optimal regional lymph Node Station according to tumor location for pancreatic cancer. Ann Surg Oncol. 2021;28:1602-1611.
Tachimori Y, Ozawa S, Numasaki H, Matsubara H, Shinoda M, Toh Y, et al. Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma. Esophagus. 2016;13:1-7.
Li K, Nie X, Li C, He W, Wang C, Du K, et al. Mapping of lymph node metastasis and efficacy index in thoracic esophageal squamous cell carcinoma: a large-scale retrospective analysis. Ann Surg Oncol. 2023;30:5856-5865.
Tashiro K, Kuroki N, Einama T, Iwasaki T, Miyata Y, Aosasa S, et al. Prognostic significance of regional lymph node metastasis according to station in ampullary carcinoma. J Hepatobiliary Pancreat Sci. 2020;27:712-720.
Kambakamba P, Linecker M, Slankamenac K, DeOliveira ML. Lymph node dissection in resectable perihilar cholangiocarcinoma: a systematic review. Am J Surg. 2015;210:694-701.
Kiriyama M, Ebata T, Aoba T, Kaneoka Y, Arai T, Shimizu Y, et al. Prognostic impact of lymph node metastasis in distal cholangiocarcinoma. Br J Surg. 2015;102:399-406.
Miyazaki M, Ohtsuka M, Miyakawa S, Nagino M, Yamamoto M, Kokudo N, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition. J Hepatobiliary Pancreat Sci. 2015;22:181-196.
Nitta N, Ohgi K, Sugiura T, Okamura Y, Ito T, Yamamoto Y, et al. Prognostic impact of paraaortic lymph node metastasis in extrahepatic cholangiocarcinoma. World J Surg. 2021;45:581-589.
Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Ohgi K, et al. Left hepatectomy with combined resection and reconstruction of right hepatic artery for bismuth type I and II perihilar cholangiocarcinoma. World J Surg. 2019;43:894-901.
Ebata T, Hirano S, Konishi M, Uesaka K, Tsuchiya Y, Ohtsuka M, et al. Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer. Br J Surg. 2018;105:192-202.
Sugiura T, Uesaka K, Okamura Y, Ito T, Yamamoto Y, Ashida R, et al. Adjuvant chemoradiotherapy for positive hepatic ductal margin on cholangiocarcinoma. Ann Gastroenterol Surg. 2020;4:455-463.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-196.
Tamura S, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, et al. The evaluation of the 8th and 7th edition of the American joint committee on cancer tumor classification for distal cholangiocarcinoma: the proposal of a modified new tumor classification. HPB (Oxford). 2021;23:1209-1216.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors (UICC). 7th ed. New York: Wiley-Blackwell; 2009.
Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.
Ito M, Mishima Y, Sato T. An anatomical study of the lymphatic drainage of the gallbladder. Surg Radiol Anat. 1991;13:89-104.
Sato T, Ito M, Sakamoto H. Pictorial dissection review of the lymphatic pathways from the gallbladder to the abdominal para-aortic lymph nodes and their relationships to the surrounding structures. Surg Radiol Anat. 2013;35:615-621.
Shirai Y, Yoshida K, Tsukada K, Ohtani T, Muto T. Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg. 1992;79:659-662.
DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245:755-762.
Kawai M, Tani M, Kobayashi Y, Tsuji T, Tabuse K, Horiuchi T, et al. The ratio between metastatic and examined lymph nodes is an independent prognostic factor for patients with resectable middle and distal bile duct carcinoma. Am J Surg. 2010;199:447-452.
Aoba T, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Assessment of nodal status for perihilar cholangiocarcinoma: location, number, or ratio of involved nodes. Ann Surg. 2013;257:718-725.
Takahashi D, Mizuno T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, et al. Adjuvant S-1 vs gemcitabine for node-positive perihilar cholangiocarcinoma: a propensity score-adjusted analysis. J Hepatobiliary Pancreat Sci. 2021;28:716-726.
Malikowski T, Levy MJ, Gleeson FC, Storm AC, Vargas EJ, Topazian MD, et al. Endoscopic ultrasound/fine needle aspiration is effective for lymph node staging in patients with cholangiocarcinoma. Hepatology. 2020;72:940-948.
Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355-366; discussion 66-8.
Yamada M, Mizuno T, Yamaguchi J, Yokoyama Y, Igami T, Onoe S, et al. Superiority of clinical American joint committee on cancer T classification for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2022;29:768-777.
Xu S, Zhang XP, Zhao GD, Zhao ZM, Gao YX, Hu MG, et al. Development and validation of an online calculator to predict early recurrence and long-term survival in patients with distal cholangiocarcinoma after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2022;29:1214-1225.