Hirose Yuki, Sakata Jun, Nomura Tatsuya, Takano Kabuto, Takizawa Kazuyasu, Miura Kohei, Ishikawa Hirosuke, Toge Koji, Ando Takuya, Abe Shun, Kawachi Yusuke, Ichikawa Hiroshi, Shimada Yoshifumi, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. Electronic address: https://twitter.com/Yuki_HIROSE.
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Surgery. 2025 Apr;180:109099. doi: 10.1016/j.surg.2024.109099. Epub 2025 Jan 16.
We investigated the rational extent of regional lymphadenectomy and evaluated the prognostic impact of number-based regional nodal classification in patients with distal cholangiocarcinoma.
This study included 191 patients with distal cholangiocarcinoma who underwent pancreaticoduodenectomy. The nos. 8, 12a-b-c-p, 13, 14, and 17 nodes were dissected routinely. The impact of the extent of lymphadenectomy on prognostic stratification performed using number-based nodal classification was evaluated.
The incidence of metastasis in the routinely dissected nodes was 1.0-25.7%, with 5-year overall survival of 0-36.4% in patients with metastasis. The incidence of metastasis in the no. 12p nodes, which were not included in regional nodes in the American Joint Committee on Cancer or International Union Against Cancer staging systems, was 5.8% with a 5-year overall survival of 36.4% in patients with metastasis. When our dissected nodes were adopted (P < .001), number-based nodal classification predicted overall survival better than when regional nodes defined by the International Union Against Cancer or American Joint Committee on Cancer staging systems were used (nos. 8, 12a-b, 13, 14, and 17 nodes with or without no. 9 nodes; P = .004 each). The 5-year overall survival in patients with pN0, pN1 (1-3 positive nodes), and pN2 (≥4 positive nodes) disease was 57.4%, 37.3%, and 13.6%, respectively (P < .001). The pN classification was an independent prognostic factor (pN1, P = .009; pN2, P < .001).
The nos. 8, 12a-b-c-p, 13, 14, and 17 nodes should be prioritized as the rational extent of regional lymphadenectomy for distal cholangiocarcinoma for accurate staging. Number-based regional nodal classification is suitable for prognostic stratification.
