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Predictors, Patterns, and Impact of Adequate Lymphadenectomy in Intrahepatic Cholangiocarcinoma

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Despite lymph node metastases (LNMs) being associated with worse survival, adequate lymph node evaluation (LNE) has not been universally adopted for intrahepatic cholangiocarcinoma (ICC). We sought to evaluate trends in LNE, predictors of LNE and LNM, as well as the role of adequate lymphadenectomy in stratifying patients relative to survival.

Methods

Patients who underwent curative-intent liver resection for ICC (2010–2019) were identified from the National Cancer Database and stratified according to LNE: 0, 1–5 (inadequate lymphadenectomy) and ≥6 (adequate lymphadenectomy). Multivariate logistic regression was utilized to assess predictors of LNE and LNM. Overall survival and receipt of adequate lymphadenectomy were assessed relative to LNM and log-odds of lymph nodes (LODDS).

Results

Among 6507 patients, adequate lymphadenectomy was performed in only 1118 (17.2%) patients, although compliance with adequate lymphadenectomy increased over time (2010–2012: 14.2% vs. 2016–2019: 18.9%; p < 0.001). After controlling for relevant factors, region (reference: Northeast; Midwest: odds ratio [OR] 1.90, 95% confidence interval [CI] 1.48–2.44; South: OR 1.64, 95% CI 1.28–2.10; West: OR 1.83, 95% CI 1.37–2.44) and preoperative nodal status (reference: cN0; cNx: OR 2.18, 95% CI 1.68–2.95; cN1: OR 3.88, 95% CI 3.02–4.98) strongly predicted adequate lymphadenectomy. Furthermore, adequate lymphadenectomy resulted in higher odds of detecting ≥1 LNMs (OR 2.63, 95% CI 2.25–3.08), regardless of preoperative nodal status. Adequate lymphadenectomy demonstrated an improved ability to stratify patients relative to 5-year survival based on LNM (N0: 51.3% vs. N1: 30.6% vs. N2: 13.7%; p < 0.001) and LODDS (LODDS1: 50.7% vs. LODDS2: 27.4% vs. LODDS3: 15.7%; p < 0.001).

Conclusions

Compliance with adequate lymphadenectomy at the time of surgery for ICC remains suboptimal with marked regional variations. Adequate lymphadenectomy was associated with higher odds of detecting LNM and improved survival stratification relative to both LNM and LODDS. Greater emphasis on nodal evaluation is required to ensure optimal management of ICC.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Columbus, OH, USA

    Zorays Moazzam MD, Laura Alaimo MD, Yutaka Endo MD, PhD, Henrique A. Lima MD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

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  1. Zorays Moazzam MD
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  2. Laura Alaimo MD
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  3. Yutaka Endo MD, PhD
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  4. Henrique A. Lima MD
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  5. Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
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Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

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Zorays Moazzam, Laura Alaimo, Yutaka Endo, Henrique A. Lima, and Timothy M. Pawlik have no conflicts of interest to declare.

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Moazzam, Z., Alaimo, L., Endo, Y. et al. Predictors, Patterns, and Impact of Adequate Lymphadenectomy in Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 30, 1966–1977 (2023). https://doi.org/10.1245/s10434-022-13044-4

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