Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma

Background: Hepatectomy with extensive lymph node dissection is the standar d operation for intrahepatic cholangiocarcinoma (IHCC). However, lymph node dissection may not always be effective at reducing tumour recurrence. Meth ods: Forty-nine patients with IHCC who underwent hepatectomy were investiga ted to determine patterns of tumour recurrence and to estimate the value of lymph node dissection during resection. Results: At hepatectomy most metas tatic lymph nodes were identified at least to the level of group 2 lymph no des. Among 23 patients who developed recurrence, 17 had liver metastases an d the other six had recurrence at other sites, mainly in the peritoneum. Po orly differentiated histology was related to the development of liver metas tases. No patient with the intraductal growth type of MCC had tumour recurr ence. Lymph node dissection did not appear to improve patient survival. His tological findings of lymph node metastases and intrahepatic metastases wer e independent indicators of poor prognosis. Conclusion-Lymph node metastase s were seldom limited to the regional lymph nodes; most tumour recurrence o ccurred in the liver. Lymph node dissection did not appear to improve patie nt survival. Lymph node dissection alone is not likely to improve the progn osis without further control of liver metastases.