Abstract
INTRODUCTIONWe sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index. METHODSData on patients who underwent curative-intent resection for pCCA between 2000-2023 were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS). The therapeutic index was determined to assess the therapeutic benefit of lymphadenectomy. RESULTSAmong 341 patients, median number of LNs evaluated was 7 (IQR: 4-11). A total of 127 (37.2%) patients underwent lymphadenectomy of station 12 only, while 146 (42.8%) patients had LNs from stations 12 plus 8 ± 13 harvested. On multivariable analysis, lymphadenectomy of stations 12 plus 8 ± 13 was associated with improved OS (referent, station 12 only: HR 0.51, 95%CI 0.32-0.80). The therapeutic index was highest among patients who underwent LN evaluation of stations 12 plus 8 ± 13 (33.1) and had ≥ 6 LNs harvested (26.3). CONCLUSIONSAt the time of surgery of pCCA, lymphadenectomy should include station 12, as well as stations 8 and 13, with the goal to evaluate > 6 LNs to ensure optimal staging and maximize the therapeutic benefit for patients.
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