Morine Yuji, Shimada Mitsuo
Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan,
J Gastroenterol. 2015 Sep;50(9):913-27. doi: 10.1007/s00535-015-1071-2. Epub 2015 Apr 2.
Lymph node (LN) metastasis from intrahepatic cholangiocarcinoma (IHCC) might be one of the most important indicators of aggressive surgical resection, yet the value of LN dissection is still controversial. To address this clinical problem, we need to better understand the multidirectional lymphatic outflow from the liver. Although most hepatic lymph flows into the hilar LNs along portal triads, there are also several lymphatic outflows directly communicating with distant areas or the general lymphatic system. Moreover, it has been revealed that LN metastasis spreads to more distal LNs through the hepatoduodenal ligament or other multidirectional lymphatic pathways connected to the general lymphatic system. Therefore, systematic LN dissection might merely be LN sampling in IHCC with LN metastasis. A multidisciplinary strategy focusing on adjuvant treatment after surgery is immediately necessary in these cases. In IHCC without LN metastasis, the accuracy of preoperative imaging assessment of LN metastasis is unsatisfactory and useless for detecting metastatic LNs in clinical settings. Therefore, prophylactic systematic LN dissection for IHCC without preoperative LN swelling is recommended for accurate LN status assessment and reduction of local recurrences. However, this procedure might not offer any clinical benefit according to the results of retrospective comparative studies. In this review, we summarize previous reports regarding lymphatic outflow of the liver and discuss LN dissection for IHCC.
肝内胆管癌（IHCC）的淋巴结（LN）转移可能是积极手术切除的最重要指标之一，但LN清扫的价值仍存在争议。为了解决这一临床问题，我们需要更好地了解肝脏的多向淋巴引流。虽然大多数肝淋巴液沿门静脉三联汇入肝门淋巴结，但也有一些淋巴引流直接与远处区域或全身淋巴系统相通。此外，研究表明，LN转移通过肝十二指肠韧带或与全身淋巴系统相连的其他多向淋巴途径扩散到更远端的淋巴结。因此，在有LN转移的IHCC中，系统性LN清扫可能仅仅是LN采样。在这些情况下，立即需要采取以术后辅助治疗为重点的多学科策略。在无LN转移的IHCC中，术前影像学评估LN转移的准确性在临床环境中对于检测转移性淋巴结并不令人满意且无用。因此，对于术前LN无肿大的IHCC，建议进行预防性系统性LN清扫，以准确评估LN状态并减少局部复发。然而，根据回顾性比较研究的结果，这一手术可能不会带来任何临床益处。在本综述中，我们总结了以往关于肝脏淋巴引流的报道，并讨论了IHCC的LN清扫。
