Lymphadenectomy for perihilar cholangiocarcinoma: therapeutic benefit of lymph node number and station

Jun Kawashima; Abdullah Altaf; Yutaka Endo; Selamawit Woldesenbet; Diamantis I Tsilimigras; Zayed Rashid; Alfredo Guglielmi; Hugo P Marques; Shishir K Maithel; Bas Groot Koerkamp; Carlo Pulitano; Federico Aucejo; Itaru Endo; Timothy M Pawlik

doi:10.1016/j.hpb.2024.11.007

Lymphadenectomy for perihilar cholangiocarcinoma: therapeutic benefit of lymph node number and station

HPB (Oxford). 2024 Nov 27:S1365-182X(24)02422-5. doi: 10.1016/j.hpb.2024.11.007. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA; Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
² Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
³ Department of Transplant Surgery, University of Rochester Medical Center, Rochester, NY, USA.
⁴ Department of Surgery, University of Verona, Italy.
⁵ Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
⁶ Department of Surgery, Emory University, Atlanta, GA, USA.
⁷ Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
⁸ Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
⁹ Department of General Surgery, Cleveland Clinic Foundation, OH, USA.
¹⁰ Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
¹¹ Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: [email protected].

PMID: 39645453
DOI: 10.1016/j.hpb.2024.11.007

Abstract

Background: We sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index.

Methods: Data on patients who underwent curative-intent resection for pCCA were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS). The therapeutic index was determined to assess the therapeutic benefit of lymphadenectomy.

Results: Among 341 patients, median number of lymph nodes (LNs) evaluated was 7 (IQR: 4-11). A total of 127 (37.2 %) patients underwent lymphadenectomy of station 12 only, while 146 (42.8 %) patients had LNs from stations 12 plus 8 ± 13 harvested. On multivariable analysis, lymphadenectomy of stations 12 plus 8 ± 13 was associated with improved OS (referent, station 12 only: HR 0.51, 95%CI 0.32-0.80). The therapeutic index was highest among patients who underwent LN evaluation of stations 12 plus 8 ± 13 (33.1) and had ≥6 LNs harvested (26.3).

Conclusion: At the time of surgery of pCCA, lymphadenectomy should include station 12, as well as stations 8 and 13, with the goal to evaluate ≥6 LNs to ensure optimal staging and maximize the therapeutic benefit for patients.