Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
J Gastrointest Surg. 2018 Apr;22(4):668-675. doi: 10.1007/s11605-017-3652-2. Epub 2017 Dec 20.
Surgical management of intrahepatic cholangiocarcinoma routinely includes resection of the hepatic parenchyma, yet the role of lymphadenectomy (LND) is more controversial. The objective of the current study was to define overall utilization, as well as temporal trends, in the utilization of LND among patients undergoing curative-intent hepatectomy for ICC using a nationwide database.
One thousand four hundred ninety-six patients who underwent curative-intent resection for ICC were identified using the SEER database from 2000 to 2013. The utilization of LND was assessed over time and by geographic region. LND utilization and the incidence of lymph node metastasis (LNM) were evaluated relative to AJCC T categories.
At the time of surgery, slightly over one-half of patients (n = 784, 52.4%) had at least one LN evaluated. Specifically, 613 (41.0%) patients had 1-5 LNs evaluated, whereas 171 (11.4%) patients had ≥ 6 LNs evaluated. The proportion of patients who had at least one LN evaluated at the time of surgery did not change with time (2000-2004: 50.5% vs. 2005-2009: 52.0% vs. 2010-2013: 53.7%) (p = 0.636). In contrast, the proportion of patients who had ≥ 6 LNs examined did increase (2000-2004: 6.9% vs. 2005-2009: 10.6% vs. 2009-2013: 14.3%) (p = 0.003). The risk of LNM was higher among patients with advanced T category tumors (Referent T1; T2a: OR 4.2, 95% CI 2.0-8.8, p < 0.001; T2b: OR 2.4, 95% CI 1.1-4.9, p = 0.018; T3: OR 3.6, 95% CI 1.6-7.9, p = 0.001; T4: OR 2.2, 95% CI 1.0-4.9, p = 0.049). In addition, the portion of patients with LNM varied among the different T categories (T1, 23.2%, T2a, 55.3%, T2b, 42.0%, T3, 51.4%, and T4, 39.5%; p = 0.001).
Utilization of LND in the surgical management of ICC across the USA remained relatively low and did not change over the last decade. Selective utilization of LND may be problematic as T-stage was not a reliable predictor of nodal status with almost a quarter of patients with early stage disease having LNM.
肝内胆管癌的外科治疗通常包括肝实质切除术，但淋巴结清扫术（LND）的作用更具争议性。本研究的目的是使用全国性数据库定义在接受 ICC 根治性肝切除术的患者中 LND 的总体利用情况以及时间趋势。
使用 SEER 数据库，从 2000 年至 2013 年，共确定了 1496 名接受 ICC 根治性切除术的患者。评估了 LND 的利用情况随时间和地理位置的变化情况。评估了 LND 的利用情况以及 AJCC T 分期的淋巴结转移（LNM）发生率。
在手术时，略多于一半的患者（n=784，52.4%）至少有一个淋巴结被评估。具体而言，613 名（41.0%）患者有 1-5 个淋巴结被评估，而 171 名（11.4%）患者有≥6 个淋巴结被评估。手术时至少有一个淋巴结被评估的患者比例没有随时间变化（2000-2004 年：50.5%vs.2005-2009 年：52.0%vs.2010-2013 年：53.7%）（p=0.636）。相反，有≥6 个淋巴结被检查的患者比例确实有所增加（2000-2004 年：6.9%vs.2005-2009 年：10.6%vs.2009-2013 年：14.3%）（p=0.003）。T 期肿瘤患者的 LNM 风险更高（参考 T1；T2a：OR 4.2，95%CI 2.0-8.8，p<0.001；T2b：OR 2.4，95%CI 1.1-4.9，p=0.018；T3：OR 3.6，95%CI 1.6-7.9，p<0.001；T4：OR 2.2，95%CI 1.0-4.9，p=0.049）。此外，不同 T 分期的患者 LNM 比例也有所不同（T1：23.2%，T2a：55.3%，T2b：42.0%，T3：51.4%，T4：39.5%；p=0.001）。
美国 ICC 外科治疗中 LND 的利用仍然相对较低，在过去十年中没有变化。LND 的选择性利用可能存在问题，因为 T 分期并不是淋巴结状态的可靠预测指标，近四分之一的早期疾病患者存在淋巴结转移。
