The impact of lymphadenectomy on intrahepatic cholangiocarcinoma management and prognosis: a comprehensive review

Abstract

Intrahepatic cholangiocarcinoma (iCCA) is a rare liver cancer generally associated with poor patient outcomes. Curative intent liver resection has been established as a standard treatment of care of resectable disease. However, the role of lymphadenectomy, including the extent of resection and therapeutic value, continues to be an area of controversy. The objective of this review was to highlight the role of lymph node dissection (LND) relative to therapeutic value and prognosis in the surgical management of iCCA. A comprehensive review was performed using MEDLINE/PubMed. Search terms included “intrahepatic cholangiocarcinoma”, “bile duct cancer”, "lymphadenectomy”, “lymph node metastasis”, and "lymph node staging”. Treatment for iCCA should include an R0 resection with regional lymphadenectomy. The prognostic and therapeutic value of regional lymphadenectomy has been an increased area of research and debate. An increased number of lymph node metastases has correlated with inferior overall survival versus lymph node-negative disease. In addition to surgical resection, regional lymphadenectomy with the removal of at least six lymph nodes in the appropriate nodal basins based on primary tumor location should be standard. The identification of lymph node metastasis provides additional important information to guide providers in determining adjuvant therapy and surveillance strategies.

Keywords

Intrahepatic cholangiocarcinoma / lymph node dissection / neoadjuvant therapy / precision medicine

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