Prognostic value of hepatectomy combined with lymph node dissection in patients with intrahepatic cholangiocarcinoma and clinical negative lymph node metastasis

doi:10.3877/cma.j.issn.2095-3232.2020.06.008

Abstract

Abstract:

Objective

To evaluate the prognostic value of hepatectomy combined with lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC) patients with clinical negative lymph node metastasis.

Methods

Clinical data of 142 ICC patients with negative lymph node metastasis who underwent radical resection in the Affiliated Hospital of North Sichuan Medical College from January 2010 to February 2018 were retrospectively analyzed. The informed consents of the patients were obtained and the local ethical committee approval was received. Among them, 77 patients were male and 65 female, aged 23-78 years witha median age of 57 years. According to whether LND was performed during operation, all patients were divided into the LND group (n=86) and non-LND (NLND) group (n=56). Patients in LND group were further divided into the lymph node metastasis (N1) group (n=38) and non-lymph node metastasis (N0) group (n=48) according to postoperative pathological findings. The effect of LND upon the prognosis of ICC patients was evaluated. Survival analysis was performed by Kaplan-Meier survival curve and Log-rank test.

Results

In NLND and LND groups, 20, 71 cases underwent hemihepatectomy and/or resection of caudate lobe, extrahepatic bile duct, respectively. The resection range in LND group was significantly larger than that in NLND group (χ2=29.233, P<0.05). The mean length of postoperative hospital stay in LND group was (19±10) d, significantly longer than (16±5) d in NLND group (t=3.961, P<0.05). The 1-, 3- and 5-year cumulative survival rates in LND group were 82%, 42% and 20%, which did not significantly differ from 89%, 47% and 34% in NLND group (χ2=0.846, P>0.05). In N1 group, the 1-, 3-, and 5-year cumulative survival rates were 63%, 14% and 0, and were 93%, 57% and 28% in N0 group.Significant difference was observed between the NLND and N1 groups (χ2=9.525, P<0.05), whereas no significant difference was observed between the NLND and N0 groups (χ2=0.300, P>0.05).

Conclusions

LND does not improve the clinical prognosis of ICC patients with clinical negative lymph nodes metastasis, whereas it increases the length of hospital stay. Routine LND should be performed with discretion.

Key words: Bile duct neoplasms, Hepatectomy, Lymph node excision, Prognosis

Xujian Huang, Facai Yang, Meng Li, Xiaopeng Liu, Taian Chen, Yi He, Qiang Li, Jian Xu, Gang Yang, Changkang Wu, Yongfu Xiong, Jingdong Li. Prognostic value of hepatectomy combined with lymph node dissection in patients with intrahepatic cholangiocarcinoma and clinical negative lymph node metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(06): 533-537.

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References 23

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分组	例数	性别（例）		年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	乙肝		肝内胆管结石		肿瘤直径（cm，±s）
分组	例数	男	女	年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	阴性	阳性	无	有	肿瘤直径（cm，±s）
NLND组	56	39	17	54±11	14(173)	43±4	25(413)	081(976)	36	20	49	7	5.3±2.1
LND组	86	38	48	56±11	12(239)	42±4	18(453)	112(999)	65	21	72	14	6.3±2.8
统计值		χ²=8.855		t=-0.002	Z=1.330	t=0.023	Z=1.844	Z=-0.918	χ²=2.107		χ²=0.384		t=-2.693
P值		0.003		0.967	0.184	0.881	0.065	0.358	0.185		0.633		0.103
分组	例数	肿瘤数目		肿瘤位置					TNM分期
分组	例数	单发	多发	左肝	右肝	尾状叶	中肝	双侧肝脏	ⅠA	ⅠB	Ⅱ	Ⅲ
NLND组	56	41	15	18	27	1	7	3	20	14	14	8
LND组	86	59	27	46	26	1	10	3	14	21	9	42
统计值		χ²=0.346		χ²=6.672					χ²=24.382
P值		0.579		0.149					<0.001
分组	例数	淋巴结		组织学分化（例）			血管侵犯（例）		神经侵犯（例）		其他侵犯（例）		癌栓（例）
分组	例数	阴性	阳性	高分化	中分化	低分化	无	有	无	有	无	有	无	有
NLND组	56	-	-	0	48	8	55	1	53	3	53	3	50	6
LND组	86	48	38	1	80	5	77	9	76	10	81	5	75	11
统计值		-		-			χ²=3.903		χ²=1.604		χ²=0.357		χ²=0.139
P值		-		0.173			0.089		0.247		0.741		0.796

分组	例数	性别（例）		年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	乙肝		肝内胆管结石		肿瘤直径（cm，±s）
分组	例数	男	女	年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	阴性	阳性	无	有	肿瘤直径（cm，±s）
NLND组	56	39	17	54±11	14(173)	43±4	25(413)	081(976)	36	20	49	7	5.3±2.1
LND组	86	38	48	56±11	12(239)	42±4	18(453)	112(999)	65	21	72	14	6.3±2.8
统计值		χ²=8.855		t=-0.002	Z=1.330	t=0.023	Z=1.844	Z=-0.918	χ²=2.107		χ²=0.384		t=-2.693
P值		0.003		0.967	0.184	0.881	0.065	0.358	0.185		0.633		0.103
分组	例数	肿瘤数目		肿瘤位置					TNM分期
分组	例数	单发	多发	左肝	右肝	尾状叶	中肝	双侧肝脏	ⅠA	ⅠB	Ⅱ	Ⅲ
NLND组	56	41	15	18	27	1	7	3	20	14	14	8
LND组	86	59	27	46	26	1	10	3	14	21	9	42
统计值		χ²=0.346		χ²=6.672					χ²=24.382
P值		0.579		0.149					<0.001
分组	例数	淋巴结		组织学分化（例）			血管侵犯（例）		神经侵犯（例）		其他侵犯（例）		癌栓（例）
分组	例数	阴性	阳性	高分化	中分化	低分化	无	有	无	有	无	有	无	有
NLND组	56	-	-	0	48	8	55	1	53	3	53	3	50	6
LND组	86	48	38	1	80	5	77	9	76	10	81	5	75	11
统计值		-		-			χ²=3.903		χ²=1.604		χ²=0.357		χ²=0.139
P值		-		0.173			0.089		0.247		0.741		0.796

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