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.