Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Department of Surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13574, South Korea.
J Gastrointest Surg. 2019 Mar;23(3):538-544. doi: 10.1007/s11605-018-3899-2. Epub 2018 Aug 15.
Intrahepatic cholangiocarcinoma is a malignancy of the intrahepatic biliary tree. Although surgical resection is the mainstay of treatment for this tumor, the impact of lymph node dissection during hepatectomy is controversial. In this study, we evaluated the impact of lymph node dissection during surgical resection for intrahepatic cholangiocarcinoma.
Records from 170 patients who underwent radical hepatectomy for intrahepatic cholangiocarcinoma from January 2000 to December 2014 were retrospectively reviewed. Twenty-two patients who underwent R1 resection or had distant metastasis at the time of surgery were excluded. Using propensity score matching (matched factors: differentiation, lymphovascular invasion, perineural invasion, and T stage), the patients were divided into two groups: no dissection (n = 34) or lymph node dissection (n = 34). Disease-free survival and overall survival were compared between groups.
There was a marginally significant difference between the two groups with respect to the disease-free survival (no dissection vs. lymph node dissection: 20.0 [4.2-35.8] months vs. 64.0 [27.3-120.8] months, p = 0.077). Overall survival was significantly longer in the lymph node dissection group (no dissection vs. lymph node dissection: 44.0 [31.1-56.9] months vs. 90.0 [51.1-158.9] months, p = 0.027).
Radical surgery including an adequate lymph node dissection area and suitable harvested lymph nodes appears to improve oncologic outcomes for intrahepatic cholangiocarcinoma.
肝内胆管细胞癌是肝内胆管的恶性肿瘤。尽管手术切除是治疗这种肿瘤的主要方法，但肝切除术中淋巴结清扫的影响仍存在争议。在本研究中，我们评估了肝切除术中淋巴结清扫对肝内胆管细胞癌的影响。
回顾性分析了 2000 年 1 月至 2014 年 12 月期间接受根治性肝切除术治疗的 170 例肝内胆管细胞癌患者的病历。排除了 22 例接受 R1 切除术或手术时存在远处转移的患者。通过倾向评分匹配（匹配因素：分化、淋巴血管侵犯、神经周围侵犯和 T 分期），将患者分为两组：无淋巴结清扫（n=34）或淋巴结清扫（n=34）。比较两组患者的无病生存率和总生存率。
两组患者的无病生存率（无淋巴结清扫组 vs. 淋巴结清扫组：20.0[4.2-35.8]个月 vs. 64.0[27.3-120.8]个月，p=0.077）有显著差异。淋巴结清扫组患者的总生存率明显更长（无淋巴结清扫组 vs. 淋巴结清扫组：44.0[31.1-56.9]个月 vs. 90.0[51.1-158.9]个月，p=0.027）。
包括足够的淋巴结清扫区域和合适的淋巴结采集在内的根治性手术似乎可以改善肝内胆管细胞癌的肿瘤学结果。
