Dong-Yu Li, Hai-Bin Zhang, Ning Yang, Yuan Quan, Guang-Shun Yang, Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
World J Gastroenterol. 2013 Dec 21;19(47):9084-91. doi: 10.3748/wjg.v19.i47.9084.
To investigate the indications for lymph node dissection (LND) in intrahepatic cholangiocarcinoma patients.
A retrospective analysis was conducted on 124 intrahepatic cholangiocarcinoma (ICC) patients who had undergone surgical resection of ICC from January 2006 to December 2007. Curative resection was attempted for all patients unless there were metastases to lymph nodes (LNs) beyond the hepatoduodenal ligament. Prophylactic LND was performed in patients in whom any enlarged LNs had been suspicious for metastases. The patients were classified according to the LND and LN metastases. Clinicopathologic, operative, and long-term survival data were collected retrospectively. The impact on survival of LND during primary resection was analyzed.
Of 53 patients who had undergone hepatic resection with curative intent combined with regional LND, 11 had lymph nodes metastases. Whether or not patients without lymph node involvement had undergone LND made no significant difference to their survival (P = 0.822). Five patients with multiple tumors and involvement of lymph nodes underwent hepatic resection with LND; their survival curve did not differ significantly from that of the palliative resection group (P = 0.744). However, there were significant differences in survival between patients with lymph node involvement and a solitary tumor who underwent hepatic resection with LND and the palliative resection group (median survival time 12 mo vs 6.0 mo, P = 0.013).
ICC patients without lymph node involvement and patients with multiple tumors and lymph node metastases may not benefit from aggressive lymphadenectomy. Routine LND should be considered with discretion.
探讨肝内胆管细胞癌（ICC）患者行淋巴结清扫术（LND）的适应证。
回顾性分析 2006 年 1 月至 2007 年 12 月行手术切除的 124 例 ICC 患者的临床资料。所有患者均行根治性切除术，除非肝十二指肠韧带以外的淋巴结（LNs）有转移。对可疑有转移的任何肿大 LNs 患者行预防性 LND。根据 LND 和 LN 转移情况对患者进行分类。收集患者的临床病理、手术和长期生存资料，分析 LND 对原发性切除术后生存的影响。
53 例行根治性肝切除联合区域 LND 的患者中，有 11 例发生淋巴结转移。无论是否有淋巴结受累的患者是否行 LND，其生存均无显著差异（P = 0.822）。5 例有多发肿瘤和淋巴结受累的患者行 LND 肝切除术，其生存曲线与姑息性切除组无显著差异（P = 0.744）。然而，有淋巴结受累和单发肿瘤行 LND 肝切除术的患者与姑息性切除组的生存差异有统计学意义（中位生存时间 12 个月 vs 6.0 个月，P = 0.013）。
无淋巴结受累和多发肿瘤伴淋巴结转移的 ICC 患者可能不能从积极的淋巴结清扫中获益。LND 应慎重考虑。
