ArticleJournal of gastrointestinal cancer2025
Resection Margin and Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma: Does Margin Status Matter in Nodal Disease?
Article in Journal of gastrointestinal cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLymph node metastasis (LNM) is a poor prognostic factor in intrahepatic cholangiocarcinoma (iCCA). However, the clinical benefit of R0 resection in patients with LNM is uncertain. This study evaluates the influence of LNM on the prognostic significance of resection margin (RM) status in iCCA.
methodsA retrospective analysis was conducted on 170 patients who underwent curative-intent liver resection for iCCA. Patients were categorized into LNM-negative (n = 87) and LNM-positive (n = 83) groups. Survival outcomes were compared based on RM status (R0 vs. R1 resection) in each group. Prognostic factors were analyzed using multivariable Cox proportional hazards regression.
resultsLNM-positive patients had significantly worse survival than LNM-negative patients (median survival time (MST): 9.8 vs. 19.9 months, p < 0.001). In LNM-negative patients, R0 resection showed a clinically meaningful, albeit not statistically significant, survival benefit (MST: 21.0 vs. 16.9 months, p = 0.145). However, in LNM-positive patients, R0 and R1 resections had comparable survival outcomes (MST: 11.1 vs. 9.0 months, p = 0.329). Multiple tumors were an independent poor prognostic factor in LNM-negative patients (HR 4.155, p = 0.004), while adjuvant therapy significantly improved survival in LNM-positive patients (HR 0.529, p = 0.009).
conclusionOur findings support a tailored surgical strategy. For LNM-negative patients, achieving an R0 resection remains critical. Conversely, for LNM-positive patients, resection margin status did not influence survival, and the surgical focus should shift towards a safe resection that preserves the patient's fitness for essential multimodal therapy, which was independently associated with improved survival.
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