{"title":"Outcomes and Role of Lymphadenectomy in Hypervascular Intrahepatic Cholangiocarcinoma Based on CT-Vascularity.","authors":"Xuefeng Li, Tomoaki Yoh, Kotaro Shimada, Yutaro Hori, Yukinori Koyama, Satoshi Ogiso, Takamichi Ishii, Hiroyoshi Isoda, Yuji Nakamoto, Etsuro Hatano","doi":"10.1002/wjs.12476","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the outcomes and role of lymphadenectomy in hypervascular intrahepatic cholangiocarcinoma (ICC) quantified using the arterial phase of contrast-enhanced computed tomography (CT).</p><p><strong>Methods: </strong>Consecutive patients with mass-forming (MF) or predominantly MF type ICC who underwent surgical resection from 2000 to 2019 were retrospectively analyzed. Using the image of the late arterial phase, CT-vascularity was calculated by dividing the CT value of the tumor (Hounsfield units) with that of the liver parenchyma. According to the CT-vascularity, patients were divided into hypervascular (CT-vascularity > 1) and non-hypervascular (CT-vascularity ≤ 1) groups. Clinicopathologic features and survival outcomes were compared between the two groups. Further, the prognostic impact of lymphadenectomy was assessed in the hypervascular group.</p><p><strong>Results: </strong>Of the 135 patients with MF-ICC, the hypervascular group, and non-hypervascular group comprised 47 (34.8%) and 88 patients (65.2%), respectively. The hypervascular group displayed clinical features typically associated with hepatocellular carcinoma (HCC) (i.e., viral hepatitis or history of HCC) and less aggressive tumor characteristics such as lower proportions of regional lymph node metastasis. The overall survival (OS) and recurrence-free survival (RFS) of the hypervascular group were significantly better than those of the non-hypervascular group (all, p < 0.001), and these results were retained after adjusting for known prognostic factors. Further, implementation of lymphadenectomy was not associated with benefit for OS and RFS in the hypervascular group (p = 0.819, p = 0.912).</p><p><strong>Conclusion: </strong>Hypervascular ICC itself represents a favorable prognosis, and there is a possibility of omitting lymphadenectomy in this subgroup.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/wjs.12476","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: This study aimed to evaluate the outcomes and role of lymphadenectomy in hypervascular intrahepatic cholangiocarcinoma (ICC) quantified using the arterial phase of contrast-enhanced computed tomography (CT).
Methods: Consecutive patients with mass-forming (MF) or predominantly MF type ICC who underwent surgical resection from 2000 to 2019 were retrospectively analyzed. Using the image of the late arterial phase, CT-vascularity was calculated by dividing the CT value of the tumor (Hounsfield units) with that of the liver parenchyma. According to the CT-vascularity, patients were divided into hypervascular (CT-vascularity > 1) and non-hypervascular (CT-vascularity ≤ 1) groups. Clinicopathologic features and survival outcomes were compared between the two groups. Further, the prognostic impact of lymphadenectomy was assessed in the hypervascular group.
Results: Of the 135 patients with MF-ICC, the hypervascular group, and non-hypervascular group comprised 47 (34.8%) and 88 patients (65.2%), respectively. The hypervascular group displayed clinical features typically associated with hepatocellular carcinoma (HCC) (i.e., viral hepatitis or history of HCC) and less aggressive tumor characteristics such as lower proportions of regional lymph node metastasis. The overall survival (OS) and recurrence-free survival (RFS) of the hypervascular group were significantly better than those of the non-hypervascular group (all, p < 0.001), and these results were retained after adjusting for known prognostic factors. Further, implementation of lymphadenectomy was not associated with benefit for OS and RFS in the hypervascular group (p = 0.819, p = 0.912).
Conclusion: Hypervascular ICC itself represents a favorable prognosis, and there is a possibility of omitting lymphadenectomy in this subgroup.
期刊介绍：
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
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