Problems of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study Using Inverse Probability of Treatment Weighting.

Abstract Background Lymph node dissection (LND) is considered to improve the prognosis of patients with intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the role of LND remains controversial. This study aimed to explore the effect of LND on the prognosis of patients with ICC from two Chinese centers.MethodsPatients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).ResultsOf 251 patients, 189 (75.2%) underwent LND, and 72 (38%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 67 patients (35.5%). Lymph node metastasis (LNM) was a risk factor with a high hazard ratio. There was no association between LND and OS after IPTW; however, LND may affect the DFS. Tumors in the LNM group were more malignant, and surgical trauma was greater in the LNM group.ConclusionsOnly a few LNDs meet the NCCN guidelines’ requirements. LND did not improve prognosis, with higher surgical trauma. The best approach for LND requires further discussion.