Management of the Nodal Basin

Abstract

The role of lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) is still debated. In fact, there is no consensus on both the extent of lymphadenectomy and on the lymph node basins that should be harvested. While the majority of centers do not perform lymphadenectomy as part of the standard surgical treatment of ICC, some authors have proposed to perform lymphadenectomy on all ICC patients. Moreover, the last edition of the AJCC TNM staging system for ICC has included the recommendation to harvest at least six lymph nodes to achieve an adequate lymph nodal staging. Even though there is no robust evidence from randomized clinical trials supporting the lymphadenectomy for ICC, results from retrospective studies suggest that lymphadenectomy should be routinely performed as part of the standard curative-intent surgical resection of ICC to properly stage patients given the lymph node status is the most important factor associated with the prognosis of ICC patients.