Lymphatic spreading pattern of intrahepatic cholangiocarcinoma

Background. There have been very few reports on the pattern of lymphatic sp read of intrahepatic cholangiocarcinoma. This pattern was elucidated to hel p define the rational extent of radical lymph node dis section. Methods. Thirty-nine consecutive patients who underwent hepatectomy with ra dical lymph node dissection, were reviewed retrospectively. Results. Lymph node metastases were detected in 24 of the 39 patients (62%) . The metastatic nodes were found in the hepatoduodenal ligament, along the common hepatic artery around the abdominal aorta, on the posterior surface of the pancreas head, along the left gastric artery, along the superior me senteric artery around the celiac artery, along the lesser curvature of the stomach, and around the cardia. The nodal involvements along the left gast ric artery, along the lesser curvature, or around the cardia were recognize d only in the left peripheral and hilar types of cholangiocarcinoma, while all other sites included both the left or right peripheral type and the hil ar type cholangiocarcinoma. Conclusions, Intrahepatic cholangiocarcinomas, irrespective of their intrah epatic location, mainly spread to the nodes in the hr;hepatoduodenal ligame nt, then to the para-aortic nodes, retropancreatic nodes, ol common hepatic artery nodes. In addition to these spreading routes, the left peripheral t ype or hilar type of cholangiocarcinoma tends to spread along the left gast ric nodes through the lesser curvature.