Bagante F, et al. - Among patients undergoing resection for intrahepatic cholangiocarcinoma (ICC), morbidity in relation to lymphadenectomy (LND) was assessed. An increased risk of complications was evident with lymphadenectomy among patients with cirrhosis undergoing surgery for ICC. Researchers recommended considering the benefit of lymphadenectomy in cirrhotic patients in light of the higher risk of postoperative complications compared with non-cirrhotic patients.

Methods

• From 1990 to 2015, they identified a total of 1,005 patients who underwent hepatectomy for ICC at one of the 14 participating institutions.
• To reduce confounding biases between cirrhosis and non-cirrhosis groups, they performed a propensity score match analysis.

Results

• In 118 (11.7%) patients, cirrhosis was diagnosed.
• Major liver resection was performed on 63% among non-cirrhotic patients, compared to only 20% among patients with cirrhosis (p < 0.001).
• Among cirrhotic vs non-cirrhotic patients LND was also less common (19 vs. 50%, p < 0.001).
• The incidence of complications was 41% among patients who did not have cirrhosis and 30% who did, respectively (p=0.022).
• One hundred and fifty patients were included in the propensity-matched cohort.
• Among patients who underwent lymphadenectomy, the incidence of complications was 71% compared to 23% among patients who did not undergo lymphadenectomy (OR 8.39) (p < 0.001).
• The propensity-matched analysis showed that the median HLN was comparable among patients independent of cirrhosis status (median HLN: non-cirrhosis, 2.5 vs. cirrhosis, 2) (p = 0.95).
• Among patients with cirrhosis, lymphadenectomy was associated with a higher risk of infections (non-cirrhosis, 0% vs. cirrhosis, 21%, p < 0.001), however, infections were not correlated with lymphadenectomy among non-cirrhotic patients (p=0.19).