Page 27 - Read Online

Page 6 of 12 Adams et al. Mini-invasive Surg 2023;7:18 https://dx.doi.org/10.20517/2574-1225.2023.12

Figure 1. Lymph node stations included in lymph node dissection for intrahepatic cholangiocarcinoma, particularly stations 12
(hepatoduodenal ligament) and station 8 (common hepatic artery). The depicted nodal stations include station 1 (right cardiac), station
3 (lesser gastric curvature), station 5 (supra-pyloric), station 7 (left gastric artery), station 8 (common hepatic artery), station 9 (celiac
axis), station 12 (hepatoduodenal ligament), station 13 (posterior pancreatic), and station 16 (abdominal aortic) [33] .

6 lymph nodes was exceedingly low in both groups (9% vs. 15%, P < 0.001) .
[40]
Historically, a need for extensive portal lymphadenectomy was considered a contraindication to LLR .
[12]
However, a propensity-score-based, case-matched analysis by Ratti et al. demonstrates that laparoscopic
LND for biliary malignancy is not only feasible but can result in adequate lymph node yield while also
providing benefits of lower blood loss, fewer intra- and post-operative blood transfusions, and shorter
length of stay compared to open LND. In addition, both overall and lymphadenectomy-related morbidity
was similar between groups. Notably, this was a single-center study at a tertiary referral center at the
Hepatobiliary Surgery Division of San Raffaele Hospital, Milano describing experiences after implementing
institutional policy to mandate LND in both MIS and OLR . Their findings support that a minimally
[41]
invasive approach to ICC is feasible and can still be oncologically sound in technically proficient hands.

Oncologic outcomes
Few studies have investigated differences in oncologic outcomes between LLR and OLR [Table 3]. Kang et
al. compared 3-year OS and DFS within the cohort from 2004 to 2015 in their center with 1:1 propensity-
score matching for age, gender, tumor location, extent of hepatectomy, and nodularity. There were no
statistical differences between 3-year DFS or OS between the LLR and OLR groups before or after matching.
Prior to matching, 3-year OS for patients undergoing LLR vs. OLR were 76.7% and 81.2% (P = 0.621),
respectively, and 3-year DFS were 65.6% and 42.5% (P = 0.122). After matching, rates became more similar
between LLR and OLR with 3-year OS of 74.8% and 75.5% (P = 0.710) and 3-year DFS of 59.9% and 41.8% (