Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma
Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma
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DOI：
10.1046/j.0007-1323.2001.01879.x
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发表时间：
2001-11-01
影响因子：
9.6
通讯作者：
Sugimachi, K
中科院分区：
文献类型：
--
作者：
Shimada, M;Yamashita, Y;Sugimachi, K
背景：肝切除加广泛淋巴结清扫是治疗肝内胆管细胞癌的标准手术方式。然而，淋巴结清扫术在减少肿瘤复发方面并不总是有效的。方法：对49例行肝切除术的IHCC患者进行调查，以确定肿瘤复发的方式，并评价术中淋巴结清扫的价值。结果：在肝切除术中，大多数转移性淋巴结被发现，至少达到第二组的水平。在23名复发的患者中，17人有肝转移，另外6人在其他部位复发，主要是在腹膜。低分化组织学与肝转移的发生有关。导管内生长型MCC患者无肿瘤复发。淋巴结清扫似乎并不能提高患者的存活率。淋巴结转移和肝内转移是预后不良的独立指标。结论：淋巴结转移很少局限于区域淋巴结；大多数肿瘤复发发生在肝脏。淋巴结清扫似乎并不能提高患者的存活率。如果不进一步控制肝转移，单纯的淋巴清扫不太可能改善预后。
Background: Hepatectomy with extensive lymph node dissection is the standard operation for intrahepatic cholangiocarcinoma (IHCC). However, lymph node dissection may not always be effective at reducing tumour recurrence. Methods: Forty-nine patients with IHCC who underwent hepatectomy were investigated to determine patterns of tumour recurrence and to estimate the value of lymph node dissection during resection. Results: At hepatectomy most metastatic lymph nodes were identified at least to the level of group 2 lymph nodes. Among 23 patients who developed recurrence, 17 had liver metastases and the other six had recurrence at other sites, mainly in the peritoneum. Poorly differentiated histology was related to the development of liver metastases. No patient with the intraductal growth type of MCC had tumour recurrence. Lymph node dissection did not appear to improve patient survival. Histological findings of lymph node metastases and intrahepatic metastases were independent indicators of poor prognosis. Conclusion-Lymph node metastases were seldom limited to the regional lymph nodes; most tumour recurrence occurred in the liver. Lymph node dissection did not appear to improve patient survival. Lymph node dissection alone is not likely to improve the prognosis without further control of liver metastases.