Limitations of the proposed lymph node classification in intrahepatic cholangiocarcinoma

The study by Kurimoto et al. represents a notable contribution to the challenging field of intrahepatic cholangiocarcinoma (ICC), particularly in the surgical management of node-positive cases. By focusing on the prognostic impact of both lymph node (LN) distribution and yield, the authors propose a new framework for defining “advanced” LN metastasis in ICC. Their multicenter design, high rate of adequate LN dissection (LND), and meticulous data analysis make this proposal both timely and thought-provoking. Nevertheless, important considerations remain unresolved. The anatomical variability of lymphatic drainage, potential post-treatment modifications, and the role of preoperative imaging all impact the real-world applicability of their model. Future prospective studies incorporating standardized PET imaging, lymphatic mapping techniques, and more detailed anatomical stratification—including mediastinal and thoracic nodes—will be essential in refining and validating this classification.