Lymph node metastasis from hilar cholangiocarcinoma: Audit of 110 patientswho underwent regional and paraaortic node dissection

Objective To assess the status of the regional and paraaortic lymph nodes i n hilar cholangiocarcinoma and to clarify the efficacy of systematic extend ed lymphadenectomy. Summary Background Data There have been no studies in which regional and pa raaortic lymphadenectomies for hilar cholangiocarcinoma have been routinely performed. Therefore, the metastasis rates to the regional and paraaortic nodes, the mode of lymphatic spread, and the effect of extended lymph node dissection on survival remain unknown. Methods This study involved 110 patients who underwent surgical resection f or hilar cholangiocarcinoma with lymph node dissection including both the r egional and paraaortic nodes. A total of 2,652 nodes retrieved from the sur gical specimens were examined microscopically. Results Of the 110 patients, 52 (47.3%) had no involved nodes, 39 (35.5%) h ad regional lymph node metastases, and 19(17.3%) had regional and paraaorti c node metastases. The incidence of positive nodes was significantly higher in the patients with pT3 disease than in those with pT2 disease. The peric holedochal nodes were most commonly involved (42.7%), followed by the perip ortal nodes (30.9%), the common hepatic nodes (27.3%), and the posterior pa ncreaticoduodenal nodes (14.5%). The celiac and superior mesenteric nodes w ere rarely involved. The 3-year and 5-year survival rates were 55.4% and 30 .5% for the 52 patients without involved nodes, 31.8% and 14.7% for the 39 patients with regional node metastases, and 12.3% and 12.3% for the 19 pati ents with paraaortic node metastases, respectively. Of the 19 patients with positive paraaortic nodes, 7 had no macroscopic evidence of paraaortic dis ease on intraoperative inspection. The survival in this group was significa ntly better than in the remaining 12 patients. Conclusion The paraaortic nodes and the regional nodes are frequently invol ved in advanced hilar cholangiocarcinoma. Whether extended lymph node disse ction provides a survival benefit requires further study. However, the fact that long-term survival is possible despite pN2 or pM1 disease encourages the authors to perform an aggressive surgical procedure with extended lymph node dissection in selected patients with hilar cholangiocarcinoma.