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ROLE OF LYMPH-NODE DISSECTION IN SMALL (≤ 3CM) INTRAHEPATIC CHOLANGIOCARCINOMA
Andrea Ruzzenente*1, Luca Viganò2, Giorgio Ercolani3, Simone Conci1, Andrea Ciangherotti1, Serena Manfreda1, Calogero Iacono1, Antonio D. Pinna3, Guido Torzilli2, Alfredo Guglielmi1
1Department of Surgery , University of Verona Medical School, Verona, Italy; 2Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy; 3Department of General and Emergency Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Background and aims: The role of lymph-node dissection (LD) in patients with small intrahepatic cholangiocarcinoma (ICC) is still under debate.
The aims of the study were to compare the lymph-node (LN) status and its correlation with survival in patients with ICC after surgery according with the tumor size
Methods: a retrospective analysis of a multi-institutional series of 259 patients submitted to curative surgery was carried out. Patients were further classified according to the tumor size in small-ICC (≤ 3cm) and large-ICC (> 3cm)
Results: Fifty-three patients had small-ICC and 206 had large-ICC. LD was performed in 194 (74.9%) patients, with a significant difference between small-ICC and large-ICC, 62% and 78%, respectively (p=0.016). LN metastases were identified in 38% of the entire cohort, in 30% and 39% of small-ICC and large-ICC, respectively (p=0.216). No differences in the number of LN retrieved, number of LN metastases and LN ratio were identified between small and large-ICC who underwent LD. The 5-years overall survival (OS) was 52% for small-ICC and 34% for large-ICC (p=0.019). The 5-years OS according to the LN status (N0 vs N+) was 85% and 36% (p=0.035) in small-ICC, and 44% and 15% in large-ICC (p<0.001), respectively.
Conclusion: Despite the lower rate of LD in small-ICC group, one third of the patients had LN metastases with important prognostic implications. LD should be performed, also in small-ICC, for a correct staging and for the allocation to adjuvant therapy.
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