ArticleJournal of the American College of Surgeons2016
Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme.
Article in Journal of the American College of Surgeons, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it, 77 citations in OpenAlex.
- Robotic surgery for perihilar cholangiocarcinoma: a concise systematic review.Surgical endoscopy · 2025Pooled it
- Can the Limits of Liver Transplantation Be Expanded in Perihilar Cholangiocarcinoma?Journal of gastrointestinal cancer · 2022Pooled it
- Prognostic Predictability of American Joint Committee on Cancer 8th Staging System for Perihilar Cholangiocarcinoma: Limited Improvement Compared with the 7th Staging System.Cancer research and treatment · 2020Trial
- Changing concepts in perihilar cholangiocarcinoma resections and surgery.International journal of surgery (London, England) · 2026Article
- Robotic-assisted surgery improves short-term outcomes of perihilar cholangiocarcinoma: a referral-center cohort study.Surgical endoscopy · 2026Observational
- Blurring the Anatomical Lines in Extrahepatic Cholangiocarcinoma: An Integrated Clinic-Oncological and Exploratory Proteomic Comparison of Perihilar and Distal Tumors.Annals of surgical oncology · 2025Article
- Prognostic Significance of Lymph Node Ratio in Intrahepatic and Extrahepatic Cholangiocarcinomas.Cancers · 2025Article
- The failure to rescue factor: aftermath analyses on 224 cases of perihilar cholangiocarcinoma.Updates in surgery · 2023Article
- Surgical management of hilar cholangiocarcinoma: Controversies and recommendations.Annals of hepato-biliary-pancreatic surgery · 2023Review
- ASO Author Reflections: Adequate Nodal Classification for Perihilar Cholangiocarcinoma.Annals of surgical oncology · 2023Article
- The Role of Alternative Lymph Node Classification Systems in Gastroenteropancreatic Neuroendocrine Neoplasms (GEP-NEN): Superiority of a LODDS Scheme Over N Category in Pancreatic NEN (pNEN).Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme · 2023Article
- Rational Extent of Regional Lymphadenectomy and the Prognostic Impact of the Number of Positive Lymph Nodes for Perihilar Cholangiocarcinoma.Annals of surgical oncology · 2023Article
- Lymph Node Staging in Perihilar Cholangiocarcinoma: The Key to the Big Picture.Current oncology (Toronto, Ont.) · 2023Article
- Minimally Invasive Surgery for Perihilar Cholangiocarcinoma: A Systematic Review of the Short- and Long-Term Results.Cancers · 2023Review
- Pure robotic major hepatectomy with biliary reconstruction for hepatobiliary malignancies: first European results.Surgical endoscopy · 2023Article
- Predictors, Patterns, and Impact of Adequate Lymphadenectomy in Intrahepatic Cholangiocarcinoma.Annals of surgical oncology · 2023Article
- Safety and feasibility of laparoscopic radical resection for bismuth types III and IV hilar cholangiocarcinoma: a single-center experience from China.Frontiers in oncology · 2023Article
- Evaluation of Four Lymph Node Classifications for the Prediction of Survival in Hilar Cholangiocarcinoma.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
- Article
- Prognostic nomogram for predicting cancer-specific survival in patients with resected hilar cholangiocarcinoma: a large cohort study.Journal of gastrointestinal oncology · 2022Article
Corrections and comments
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Authors and funding
27 authors at 13 institutions in 3 countries.
Funding
Abstract
backgroundThe role of routine lymphadenectomy for perihilar cholangiocarcinoma is still controversial and no study has defined the minimum number of lymph nodes examined (TNLE). We sought to assess the prognostic performance of American Joint Committee on Cancer/Union Internationale Contre le Cancer (7(th) edition) N stage, lymph node ratio, and log odds (LODDS; logarithm of the ratio between metastatic and nonmetastatic nodes) in patients with perihilar cholangiocarcinoma and identify the optimal TNLE to accurately stage patients.
methodsA multi-institutional database was queried to identify 437 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 1995 and 2014. The prognostic abilities of the lymph node staging systems were assessed using the Harrell's c-index. A Bayesian model was developed to identify the minimum TNLE.
resultsOne hundred and fifty-eight (36.2%) patients had lymph node metastasis. Median TNLE was 3 (interquartile range, 1 to 7). The LODDS had a slightly better prognostic performance than lymph node ratio and American Joint Committee on Cancer, in particular among patients with <4 TNLE (c-index = 0.568). For 2 TNLE, the Bayesian model showed a poor discriminatory ability to distinguish patients with favorable and poor prognosis. When TNLE was >2, the hazard ratio for N1 patients was statistically significant and the hazard ratio for N1 patients increased from 1.51 with 4 TNLE to 2.10 with 10 TNLE. Although the 5-year overall survival of N1 patients was only slightly affected by TNLE, the 5-year overall survival of N0 patients increased significantly with TNLE.
conclusionsPerihilar cholangiocarcinoma patients undergoing radical resection should ideally have at least 4 lymph nodes harvested to be accurately staged. In addition, although LODDS performed better at determining prognosis among patients with <4 TNLE, both lymph node ratio and LODDS outperformed compared with American Joint Committee on Cancer N stage among patients with ≥4 TNLE.
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Registered trials
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