Impact of Positive Lymph Nodes and Resection Margin Status on the Overall Survival of Resected Perihilar Cholangiocarcinoma, the ENS-CCA Registry

Abstract

Background: Lymph node metastasis and radical resection margins have been reported to be major determinants for overall survival (OS) and poor recurrence free survival of patients with resected perihilar cholangiocarcinoma (pCCA). A study of independency between positive lymph nodes and resection margins on OS, has however not been investigated. Methods: From the European Cholangiocarcinoma registry (ENS-CCA), patients undergoing resection for pCCA between 1994 and 2021 were included in this retrospective cohort study. The primary outcome was OS stratified for resection margin and lymph node status (AJCC8th). Secondary outcome was time to recurrence. Results: A total of 325 patients from eleven different centers from six countries were included. Of these, 194 (59.7%) patients had undergone an R0 resection. In 113 (34.8%) patients, positive lymph nodes were found. In the latter group, the median number of retrieved lymph nodes was 5 (IQR: 3 – 7) and the median number of positive lymph nodes was 2 (IQR: 1 - 3). Lymph node status, histological grade and ECOG performance status were independent prognostic factors for survival. The median OS for N0R0, N0R1, N+R0 and N+R1 was 38, 30, 18 and 12 months, respectively (P < 0.001), Figure 1. Median time to recurrence was 16 months, and occurred earlier in lymph node positive patients. Conclusion: In conclusion, our results suggest that in patients with positive lymph nodes, negative resection margin becomes irrelevant. Therefore, patients with positive lymph nodes may not benefit from more extensive resections to obtain negative margins.