The value of lymph node dissection for intrahepatic cholangiocarcinoma: a systemic review and meta-analysis

Abstract

Introduction: Although lymph node metastasis was an adverse prognostic factor in patients who underwent hepatic resection for intrahepatic cholangiocarcinoma (ICC), the benefit of performing an lymph node dissection (LND) remains controversial. Our aim is to investigate whether LND could confer any survival benefit in patients with ICC. Method: A comprehensive search of several databases was performed to identify comparative studies evaluating survival outcomes between patients with and without LND. Overall survival (OS) and disease-free survival (DFS) were pooled by using the hazard ratio (HR) and the corresponding 95% confidence interval (CI). Result: Nine case-control studies were identified, including 1292 patients who underwent LND and 902 who did not undergo LND. Patients in the LND(+) group had a better OS than the LND(-) group, but the difference was not statistically significant (HR=0.76, 95%CI 0.58-1.00, Z = 1.93, P = 0.05). Pooled analysis revealed a significantly poorer DFS for patients without LND compared to patients with LND (HR, 0.70; 95% CI, 0.55-0.88, P=0.003). Subgroup analyses revealed that the OS of patients without lymph node metastasis is significantly better than those with lymph node metastasis (P<0.00001). There was no significant difference in the OS between patients without lymph node metastasis and patients who did not undergo LND (P=0.47). Conclusion: Routine LND can improve DFS rather than OS in the patient who underwent hepatic resection for ICC. LND might be useful to confirm tumor staging, to predict prognostic outcomes and to decide whether to apply adjuvant treatments.