Although clinically node-negative (cN0) patients should have lymphadenectomy, lymph node status is a significant predictor of survival in intrahepatic cholangiocarcinoma (ICC). However, it was up for discussion. For a study, researchers sought to establish if a sufficient lymphadenectomy enhanced long-term results in cN0 patients having their livers removed for ICC.

Retrospective cohort analysis of patients who received cN0 ICC-related radical liver resection at 5 tertiary referral centers throughout time. Preoperative data were utilized to establish a propensity score, which was then used to create an inverse probability of treatment weighting (IPTW). Patients receiving sufficient (≥6 retrieved lymph nodes) vs. inadequate lymphadenectomy were evaluated for overall survival and recurrence-free survival. Through Cox IPTW-weighted regression, the interactions between the sufficiency of the lymphadenectomy and the clinical factors of interest were investigated.

About 706 cN0 individuals with intrahepatic cholangiocarcinoma who received curative surgery were included in the research. Four hundred seventeen (59.1%) people had sufficient lymphadenectomy. The median overall survival was 39 months (IQR: 23-109), and the median recurrence-free survival was 23 months (IQR: 8-74) after a median follow-up of 33 months (IQR: 18-77). Node-positive patients exhibited longer overall survival (28 months vs. 23, HR=1.82; 95%CI: 1.14-2.90; P=0.023) and disease-free survival (13 months vs. 9, HR=1.35; 95%CI: 1.14-1.59; P=0.008) following appropriate lymphadenectomy after stratifying by nodal status at final pathology. In individuals without chronic liver illness and in those with less advanced tumors (solitary tumors, tumor size <5 cm, Ca19.9 <200 U/mL), adequate lymphadenectomy dramatically improved survival results.

The regular use of appropriate lymphadenectomy for cN0 intrahepatic cholangiocarcinoma was supported by the higher survival results for cN0 patients who were discovered to be node-positive at pathology.

Reference: journal-of-hepatology.eu/article/S0168-8278(22)03158-0/fulltext