Detailed Abstract
[Liver Best Oral Presentation - Liver (Liver Disease/Surgery)]
[LV BEST OP 1] Examination of optimal lymph node dissection for mass-forming type intrahepatic cholangiocarcinoma
Makoto KURIMOTO1 , Tomoaki YOH*1 , Keisuke OKURA1 , Yuichi TAKAMATSU1 , Yutaro HORI1 , Hiroto NISHINO1 , Takahiro NISHIO1 , Yukinori KOYAMA1 , Satoshi OGISO1 , Takamichi ISHII1 , Koichiro HATA1 , Etsuro HATANO1
1 Department Of Surgery, Graduate School Of Medicine, Kyoto University, JAPAN
Background : Lymph node metastasis is a major poor prognostic factor for intrahepatic cholangiocarcinoma (ICC). However, there is no clear consensus on the optimal number of lymph nodes or extent of lymph node dissection for ICC.
Methods : Among hepatectomy cases (R0/R1 resection) with lymph node dissection performed for mass-forming type (MF) and MF plus periductal infiltrating type (MF+PI) ICC in our department from 2002 to 2020, 92 patients whose clinical and pathological findings of lymph node dissection were available were included. Analysis 1; the association of the number of lymph nodes dissected and the prognosis in pN0 cases, Analysis 2; the association of the number of lymph node metastasis and the prognosis in pN1 cases, Analysis 3; the effect of lymph node dissection of the gastro-hepatic area on the prognosis of left-side ICC. The minimum p-value approach was used to determine the optimal cut-off values of continuous variables.
Results : In all cases, the median overall survival(OS) was 57.8 months, and the median recurrence-free survival(RFS) was 17.8 months. The median number of lymph nodes dissected was 14 (1-56). 66(71.7%) patients were pN0 and 26(28.3%) patients were pN1. The median OS was pN0: 90.3 months, and pN1: 24.3 months. The median RFS was pN0: 31.2 months, and pN1: 7.6 months. Analysis 1. The OS of pN0 cases(n=66) was significantly stratified by the number of dissected lymph nodes, >8 vs ≤8 (102.6 months vs. 57.2 months, p=0.041, generalized Wilcoxon test). Analysis 2. There was no optimal cut-off point on the number of lymph node metastasis that stratified the survival outcomes in pN1 cases(n=26). All pN1 cases had lymph node metastasis of #8, #12, or #13. Analysis 3. In the left-side ICC cases(n=49), There is no independent lymph node metastasis in the gastro-hepatic area. The OS was not stratified by comparing the presence or absence of lymph node dissection in the gastro-hepatic area (with dissection: n=10, without dissection: n=39, p=0.739).
Conclusions : 1. Harvest and/or retrieval of ≥ 9 LNs is recommended for ICC. 2. LN metastasis is a poor prognostic factor regardless of the number. 3. Survival benefit of LND of the gastro-hepatic area is limited.
Methods : Among hepatectomy cases (R0/R1 resection) with lymph node dissection performed for mass-forming type (MF) and MF plus periductal infiltrating type (MF+PI) ICC in our department from 2002 to 2020, 92 patients whose clinical and pathological findings of lymph node dissection were available were included. Analysis 1; the association of the number of lymph nodes dissected and the prognosis in pN0 cases, Analysis 2; the association of the number of lymph node metastasis and the prognosis in pN1 cases, Analysis 3; the effect of lymph node dissection of the gastro-hepatic area on the prognosis of left-side ICC. The minimum p-value approach was used to determine the optimal cut-off values of continuous variables.
Results : In all cases, the median overall survival(OS) was 57.8 months, and the median recurrence-free survival(RFS) was 17.8 months. The median number of lymph nodes dissected was 14 (1-56). 66(71.7%) patients were pN0 and 26(28.3%) patients were pN1. The median OS was pN0: 90.3 months, and pN1: 24.3 months. The median RFS was pN0: 31.2 months, and pN1: 7.6 months. Analysis 1. The OS of pN0 cases(n=66) was significantly stratified by the number of dissected lymph nodes, >8 vs ≤8 (102.6 months vs. 57.2 months, p=0.041, generalized Wilcoxon test). Analysis 2. There was no optimal cut-off point on the number of lymph node metastasis that stratified the survival outcomes in pN1 cases(n=26). All pN1 cases had lymph node metastasis of #8, #12, or #13. Analysis 3. In the left-side ICC cases(n=49), There is no independent lymph node metastasis in the gastro-hepatic area. The OS was not stratified by comparing the presence or absence of lymph node dissection in the gastro-hepatic area (with dissection: n=10, without dissection: n=39, p=0.739).
Conclusions : 1. Harvest and/or retrieval of ≥ 9 LNs is recommended for ICC. 2. LN metastasis is a poor prognostic factor regardless of the number. 3. Survival benefit of LND of the gastro-hepatic area is limited.
SESSION
Liver Best Oral Presentation
Room B 3/23/2023 11:00 AM - 12:10 PM