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Prognostic impact of lymph node and surgical margin in patients with perihilar cholangiocarcinoma
Yifei Yang1, Jianjie Sheng2, Ailixier Aibaidula1
1Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
Background:
The study aimed to assess the prognostic impact of lymph node (LN) metastasis combined with surgical margin status on the 5-year overall survival (OS) of patients after radical resection perihilar cholangiocarcinoma (PHCC).
Methods:
Clinicopathological data of patients with PHCC who underwent curative resection between June 2014 and June 2022 were analyzed retrospectively. Cox regression analyses were performed to evaluate the risk factors for OS and LN metastasis. Kaplan-Meier method with log-rank test was performed for OS curves.
Results:
71 patients were enrolled and the 5-year OS rate was 52.4%. Poor differentiation grade, R1/2 resection, and the presence of LN metastasis were the independent prognostic factors of poor OS. In patients without LN metastasis, the 5-year OS rate was significantly higher in patients with negative surgical margin than patients with positive surgical margin. In LN metastasis positive patients, a comparable 5-year OS rate was found between patients with and without positive surgical margin (P = 0.185).
Conclusions:
In patients with curatively resected for PHCC, R1 resection margin does not influence OS in patients with LN metastasis even when radical resection was achieved. Consequently, the risk of highly invasive procedures aimed at achieving R0 margins should be judiciously weighed against potential morbidity risk in patients with LN metastasis, as aggressive surgical strategies may not translate to survival benefits.
