Routine Lymph Node Dissection in the Surgical Treatment of Primary Liver Tumors: a Systematic Review and...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Lymph node metastasis (LNM) incidence and survival outcomes after routine lymph node dissection (LND) in hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and perihilar cholangiocarcinoma (PCC) resections are not well-defined.
• Routine LND is a common surgical practice, but its specific benefit in these malignancies requires clarification.

Purpose of the Study:

• To systematically review and meta-analyze the incidence of LNM and survival outcomes following routine LND in patients undergoing resection of HCC, ICC, and PCC.
• To evaluate the impact of LNM on overall survival (OS) in these patient groups.

Main Methods:

• A systematic search of the PubMed database was conducted from inception until March 2025.
• Random-effects meta-analysis was employed to determine the pooled incidence of LNM and hazard ratios (HRs) for OS for each malignancy.

Main Results:

• Forty studies involving 5,872 patients were included in the analysis.
• The incidence of LNM following routine LND was 5% for HCC, 37% for ICC, and 39% for PCC.
• LNM was significantly associated with worse OS in ICC (HR: 2.46) and PCC (HR: 2.01) patients, but not explicitly detailed for HCC in the provided results.

Conclusions:

• Routine LND is recommended for ICC and PCC resections due to high LNM rates and association with improved survival outcomes.
• Routine LND is not recommended for HCC resection based on the current findings.
• The presence of LNM negatively impacts survival outcomes in ICC and PCC patients.