Guan J F, Wang K
Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330008, China.
Zhonghua Wai Ke Za Zhi. 2020 Jan 1;58(1):48-51. doi: 10.3760/cma.j.issn.0529-5815.2020.01.011.
Lymphatic metastasis is an independent prognostic factor for surgical prognosis of patients with hilar cholangiocarcinoma (HCCA) . Lymph node dissection is an important content of radical resection of HCCA, but there are still many disputes about the definition, scope and dissection numbers of intraoperative lymph node dissection. There has been a lot of research being done at home and abroad in recent years focusing on the above problems, and novel insights have also been proposed.According to the current view, routine skeletal dissection of lymph nodes in the duodenum ligament of liver, the common hepatic artery, and the posterior part of the duodenum of pancreas head (the 12(th) group, the 8(th) group and the 13(th) group) during operation can bring significant survival benefits to patients with HCCA. However, it is still not clear whether the dissection of peripheral lymph node in truncus coeliacus, aorta abdominalis, and venae cava inferior during operation can bring survival benefits to HCCA patients during operation. Properly increasing the number of lymph node dissection during operation can not only significantly improve the survival prognosis of the patients of HCCA with stage N0, but also improve the detection rate of positive lymph nodes and obtain enough information for the stage of the disease. However, the excessive increase of total lymph node count is not only difficult to achieve in practice, but may also lead to an increase in the incidence of postoperative complications. Therefore, further investigation is needed in intraoperative lymph node dissection of HCCA.
淋巴结转移是肝门部胆管癌（HCCA）患者手术预后的独立预后因素。淋巴结清扫是HCCA根治性切除的重要内容，但术中淋巴结清扫的定义、范围及清扫数量仍存在诸多争议。近年来，国内外针对上述问题进行了大量研究，并提出了新的见解。按照目前的观点，术中常规清扫肝十二指肠韧带、肝总动脉及胰头十二指肠后部的淋巴结（第12组、第8组和第13组）可给HCCA患者带来显著的生存获益。然而，术中清扫腹腔干、腹主动脉及下腔静脉周围淋巴结是否能给HCCA患者带来生存获益仍不明确。术中适当增加淋巴结清扫数量不仅能显著改善N0期HCCA患者的生存预后，还能提高阳性淋巴结的检出率，并为疾病分期获取足够信息。然而，淋巴结总数过度增加不仅在实际操作中难以实现，还可能导致术后并发症发生率增加。因此，HCCA术中淋巴结清扫仍需进一步研究。
