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PubMed1996

Comparison of virus burden in blood and sequential lymph node biopsy specimens from children infected with human immunodeficiency virus.

BACKGROUND: Lymph nodes serve as reservoirs for the replication of human immunodeficiency virus (HIV) type 1. Comparison of serial measurements of virus burden in lymph nodes and peripheral blood after a change in antiretroviral therapy may provide insights into pathogenic mechanisms and permit a more accurate assessment of a therapeutic response. STUDY DESIGN: Nevirapine was added to the drug regiment of eight children with HIV infection treated with the combination of zidovudine and didanosine who had increasing levels of serum p24 antigen. Lymph node biopsies were performed at entry and after 12 weeks of therapy. RESULTS: Neither CD4 counts nor p24 antigen level correlated with the degree of viremia as measured by ribonucleic acid copy numbers in plasma. Correlations were found between HIV DNA copy number in peripheral blood mononuclear cells and HIV DNA copy number in lymph nodes (p = 0.02), as well as between peripheral blood CD4 counts and lymph node architecture. The HIV signals in the lymph nodes conformed to the anatomic organization of apical light zones in the germinal centers; however, in more advanced disease stages, organized germinal centers disappeared as evidence by a decline in the extent of the follicular dendritic network. CONCLUSIONS: Lymph node biopsies in this small number of HIV-infected children revealed a progressive loss of an organized architecture, especially of the follicular dendritic network. This correlated with a progressive loss of CD4+ cells but not with other measures of disease stage, including viral load, as measured by ribonucleic acid copy numbers.

Antiviral Agents↗

PubMed1993

Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe.

We have recently reported on a technique of gamma probe localization of radiolabelled lymph nodes to identify the sentinel node in malignant melanoma. In order to determine whether this technique is applicable to assist in staging breast cancer, a pilot study was begun to address two questions: (i) can the sentinel lymph node draining a breast cancer be identified for selective resection; and (ii) is the sentinel lymph node predictive of the status of the entire axillary lymph nodes? One to four hours prior to axillary lymph node dissection, 22 consecutive patients had approximately 0.4 mCi of technetium sulfur colloid in 0.5 ml saline injected around the perimeter of the breast lesion. A hand-held gamma counter was used at surgery to locate the lymph node(s) receiving drainage from the breast. A sentinel lymph node was identified in 18 of 22 patients. Of these 18 patients, the sentinel lymph node was positive in seven of seven patients, with pathologically verified metastatic breast cancer to at least one lymph node. In three out of seven patients, the sentinel lymph node was the only lymph node with metastatic cancer. In this pilot study of breast cancer patients, we conclude that: (i) radiolocalization and selective resection of sentinel lymph nodes is possible; and (ii) the sentinel lymph node appears to predict correctly the status of the remaining axilla. These data justify a larger clinical trial to verify the value of this technique.

Adult↗

PubMed2003

[Characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on prognosis].

BACKGROUND & OBJECTIVE: Occult cervical lymph node metastasis in squamous cell carcinoma of tongue has regularity and influence on the prognosis of patients. This study was designed to investigate the characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis to provide clinical bases for elective supraomohyoid neck dissection. METHODS: The data of 164 patients with squamous cell carcinoma of tongue who were treated in cancer center, Sun Yat-sen University, from 1990 to 1996 were reviewed. The characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis were analyzed. RESULTS: The rate of occult cervical lymph node metastasis of squamous cell carcinoma of tongue was 25.71%. The most common site of occult cervical lymph node metastasis was ipsilateral level II, and followed by ipsilateral level I and III. 82.98% of the lymph nodes of occult metastasis occurred in the above three levels. Most cervical lymph nodes of occult metastasis were found within two years after the first operation (33/36). There was significant difference of the prognosis between the group of dominant or occult cervical lymph node metastasis and the group of without cervical lymph node metastasis in squamous cell carcinoma of tongue (log-rank,P< 0.01); whereas there was no significant difference of the prognosis between the group of dominant cervical lymph node metastasis and the group of occult cervical lymph node metastasis according to log-rank test (P >0.05). CONCLUSION: The ipsilateral level I to level III were the common regions where occult cervical lymph node metastasis occurred. The authors suggest that elective supraomohyoid neck dissection may be applied to clinically negative neck of the patients with squamous cell carcinoma of tongue who were prone to metastasize latently. Occult cervical lymph node metastasis influences the prognosis of patients with squamous cell carcinoma of tongue significantly.

Adult↗

PubMed2000

[Characteristics of lymph node metastasis of squamous cell carcinoma of thoracic esophagus and its clinical significance].

OBJECTIVE: To study the characteristics of lymph node metastases of squamous-cell carcinoma of thoracic esophagus and its influence on patients' prognosis and find reasonable dissecting approaches of lymph nodes. METHODS: To analyse retrospectively the clinical materials of 243 patients who had undergone resection of squamous-cell carcinoma of thoracic esophagus. RESULTS: Lymph node metastases was found in 110 of the 243 treated patients (45.3%). In 3,813 lymph nodes dissected, metastases existed in 400 (10.5%). The cancer cells disseminated upward and downward to lymph nodes along the esophagus. Tumor differentiation and the depth of tumor invasion were factors influencing lymph node metastases, but the length of tumor was not. The 5-year survival rate of the patients with lymph node metastasis was 16.4%, being much lower than that of patients with no lymph node metastasis (51.9%). The numbers of lymph node metastases had little influence on patients' prognosis. CONCLUSION: Because of the different upward and downward spreading of esophageal cancer cells to the lymph nodes, different lymph node dissecting approaches should be taken. The thoracic, and abdominal regional (two fields) lymph nodes dissection could be appropriate to esophageal carcinoma of the lower thoracic segment, and the cervical, thoracic and abdominal (three fields) lymph node dissection should be done for patients with earlier esophageal carcinoma of upper or middle thoracic segments.

Adult↗

PubMed1991

The value of single versus multiple sections for detection of lymph node metastasis.

This study was undertaken to determine the value of serial sectioning of lymph nodes as an aid in optimally examining cervical specimens for metastasis. The presence or absence of lymph node metastasis in 802 lymph nodes obtained from 51 consecutive neck dissection specimens were initially determined by the routine method, examination of one section from each node. This examination revealed 40 lymph nodes with metastatic involvement. Further study of the 716 lymph nodes that were initially interpreted as free of tumor by serial sectioning added only two positive nodes. Thus, serial sectioning did not contribute significantly to the detection of lymph node metastasis.

Humans↗

PubMed1999

The significance of breast cancer lymph node micrometastases.

The significance of breast cancer lymph node micrometastasis has been addressed by numerous studies. Although the results of these studies are mixed, most of the larger trials strongly suggest that the presence of a lymph node micrometastasis, in the absence of other nodal disease, will have a negative impact on disease free survival and on overall survival. The focus of this article is to analyze the biologic and therapeutic significance of micrometastatic disease in the axillary lymph nodes of patients with breast cancer.

Axilla↗

PubMed2000

Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas.

Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease.

Adult↗

PubMed1981

[Anatomy and topography of the parasternal lymph nodes in the adult].

A topographo-anatomical study of parasternal lymph nodes in male and female humans, aged 22--85, carried out. Lymph nodes were identified by preparation method, following interstitial injection of Jerota's blue fluid into mammary tissue, diaphragmatic surface of the liver, pleura, pericardium and diaphragm. The numbers of parasternal lymph nodes were determined for each age bracket of males and females. Parasternal lymph nodes at the level of intercostal spaces and costal cartilages on both sides of the sternum were counted. Relatively more lymph nodes were found at the right-hand side than at the left. There are relatively more parasternal lymph nodes at the level of three upper intercostal spaces on both sides of the sternum; these nodes are larger, too.

Adult↗

PubMedDate not supplied

Perigastric lymph nodes with metastasis in gastric cancer.

BACKGROUND/AIMS: We analyzed the significance of metastasis to the subdivided perigastric lymph node stations according to the distance from the primary gastric cancer, and the appropriateness of the recent change in the Union Internacional Contra la Cancrum (UICC) tumor node metastasis (TNM) system. METHODOLOGY: Gastrectomy was performed in 753 patients with gastric cancer. The perigastric lymph nodes were divided into 6 stations according to the Japanese classification. These were subdivided into 2 categories according to the distance from the primary tumor: -1, nodes within 3 cm of the edge of the tumor; and -2, nodes more than 3 cm from the edge of the tumor. Survival rates were calculated with the Kaplan-Meier method, and the difference between each group was evaluated by the log-rank method. RESULTS: The frequency of metastasis to the subdivided perigastric lymph node stations, numbered 1-1 to 6-2, varied between 10.0% and 41.1%. The 5-year survival rate of the patients with positive 6-1 lymph node was higher than that of the patients with positive 6-2 lymph node (31.5% and 17.5%, P = 0.0032). There were no statistically significant differences in survival between subgroups of patients who had metastatic lymph node in the other 5 stations. The frequency of metastasis to other regional lymph nodes in patients with N2 perigastric lymph nodes was higher than that in patients with N1 perigastric lymph nodes. CONCLUSIONS: Subdivision of the perigastric lymph nodes had little advantage. Elimination of the old system of classifying perigastric lymph nodes according to distance from the tumor is appropriate.

Female↗

PubMed2003

Preoperative ultrasonographic identification of the sentinel lymph node in patients with malignant melanoma.

BACKGROUND: Dissection of the "sentinel lymph node" (SLN) as identified by lymphoscintigraphy is becoming increasingly important in the treatment of patients with malignant melanoma. The purpose of the current study was to determine whether the SLN also could be identified by ultrasound. METHODS: Sixty-seven patients with malignant melanoma (40 females and 27 males, with an average age of 48.8 years) in whom extirpation of the SLN was indicated underwent ultrasonography of the regional lymph nodes prior to preoperative lymphoscintigraphy. The location of the melanoma was the legs in 30 patients, the arms in 14 patients, and the trunk in 23 patients. During regional ultrasonography, the location of the lymph nodes that differed in the cortex/medulla ratio from the surrounding lymph nodes was marked on the skin corresponding to the planes of insonation (M1) when the probe was held vertically to the skin surface. After lymphoscintigraphy using technetium-99m, the position of a gamma probe at which the highest count rate vertical to the skin surface was recorded also was marked (M2). RESULTS: In the inguinal region, the agreement between M1 and M2 was found to be 100% (40 of 40 SLNs) and was 72.5% in the axilla (29 of 40 SLNs). In patients with melanomas located on the leg, the location of M1 and M2 agreed in 97% of cases (36 of 37 lymph nodes in 30 patients); in patients with melanomas located on the arms, the agreement was 76% (13 of 17 lymph nodes in 14 patients) and in patients with melanomas located on the trunk, the agreement was 75% (21 of 28 lymph nodes in 23 patients). The position documented by ultrasound relative to the neighboring structures of the SLN was confirmed intraoperatively in all cases. CONCLUSIONS: The results of the current study indicate that the SLN in patients with melanoma located on the limbs, especially the legs, are characterized by a specific sonomorphologic pattern. Preoperative sonography might constitute an important addition to lymphoscintigraphy in the planning of SLN biopsy.

Female↗

PubMed1984

Azygos lymph node enlargement as initial manifestation of underlying disease.

Azygos lymph node enlargement is usually an indication of advanced bronchogenic carcinoma, although it may occur in benign pulmonary disease. Often it is found in conjunction with enlargement of hilar and other mediastinal lymph nodes. Isolated azygos lymph node enlargement is unusual and demands tissue diagnosis. Four patients without other evidence of underlying disease were evaluated because of roentgenographic finding of azygos lymph node enlargement. Three had malignant disease and one reactive lymphoid hyperplasia. Current concepts of mediastinal lymphatic drainage are presented. Because of the likelihood of underlying malignancy, biopsy examination of an enlarged azygos node by cervical mediastinoscopy is indicated.

Adenocarcinoma↗

PubMed1996

Modified clearing technique to identify lymph node metastases in post-irradiated surgical specimens from rectal adenocarcinoma.

The aim of this study is to describe a modification of the original method of clearing lymph nodes in specimens from rectal adenocarcinoma and its yield in comparison to a control group whose specimens were studied by a manual technique. There were 32 consecutive patients with locally advanced rectal adenocarcinoma. All patients received preoperative radiation therapy (PRT) at doses of 45 Gy, concomitant with 5-fluorouracil at the doses of 450 mg/m2 IV bolus, days 1-5 and 28-33 of PRT; 4-8 weeks later radical surgery with a curative intent was performed. Twenty two specimens were studied by a manual technique consisting of fixation in 10% formalin. Ten specimens were studied with the modified clearing technique consisting of administration through the inferior mesenteric artery of methylene blue; fixation with 10% formalin plus 0.01% of methylene blue; clearing the fat with a sequence of 95% alcohol-100% acetone-100% xylene. In the 32 specimens, 413 lymph nodes were found. Using the manual technique 104 lymph nodes were found (average 4.7 lymph nodes per specimen); 309 lymph nodes by the modified clearing technique (average 30.9 lymph nodes per specimen), (p < 0.0001). Using the manual technique 23 out of 104 lymph nodes (22%) contained metastases. All metastatic lymph nodes measured > 5 mm; 18 out of 23 metastatic lymph nodes were located on the perirectal area (level 2); and five were located in the root of the inferior mesenteric artery (level 5). Using the modified clearing technique 278 out of 309 (89%) lymph nodes measured < 5 mm; 15 out of 309 (4.8%) lymph nodes contained metastases; 9 out of 15 (60%) measured > 5 mm and were located on levels 2 and 5; and six, located on level 5, measured < 5 mm. The modified clearing technique is a quick, easy and reproducible method for identifying lymph nodes in post-irradiated surgical specimens. In comparison to the traditional manual method of searching for lymph nodes, it improves in the detection of small lymph nodes (< 5 mm), allowing better staging in patients with rectal adenocarcinoma.

Adenocarcinoma↗

PubMed2002

[Significance of resecting the head of the pancreas for the treatment of gallbladder cancer from the perspective of surgical results and mode of lymph node metastasis].

The significance of resecting the head of the pancreas was clinicopathologically investigated, predominantly by examining the mode of lymph node metastasis, in patients with gallbladder cancer. Of 60 patients who underwent resection of gallbladder cancer, 24 patients (40.0%) had lymph node metastasis. The breakdown of lymph node metastases was as follows: 12b (24.0%), 16 (21.7%), 13 (17.1%), 8 (12.2%), 12c (12.0%), 12p (8.0%), and 6 (6.3%). Of 45 patients with advanced gallbladder cancer, 14 patients survived more than 5 years after surgery. In the absence of lymph node metastasis, there were some long-term survivors following D0 dissection, gallbladder resection, or liver bed resection. However, all five long-term survivors with lymph node metastasis underwent S4aS5 resection combined with pylorus preserving pancreatoduodenectomy (PPPD) and D3 dissection. Seven patients had number 13 lymph node metastasis, and only two n2 patients who underwent S4aS5 resection combined with PPPD and D3 dissection, survived more than 5 years. There were no long-term survivors with n3 lymph node metastasis. Of the 50 patients who underwent curative resection, 13 patients experienced recurrence: in the liver in six patients, in the peritoneum in four patients, in the lymph nodes in four patients, in the bone in two patients, in the lung in one patient, and local in one patient (including duplicate cases). Of the four patients with lymph node recurrence, two demonstrated number 12 and/or number 13 lymph node metastasis at the time of surgery and underwent bile duct-conserving D2 dissection, although cancer recurred in the head of the pancreas, probably due to recurrence in number 13 lymph node. Extensive resection including resection of the head of the pancreas was therefore effective in patients with up to n2 lymph node metastasis as long as the cancer could be completely sected.

Adult↗

PubMed2001

Electrical impedance scanning: a new technique in the diagnosis of lymph nodes in which malignancy is suspected on ultrasound.

Differentiation between inflammatory and malignant lymph nodes by ultrasound is difficult. Electrical impedance scanning (EIS) is a new diagnostic tool, so far used primarily for the identification of malignant breast lesions. Cancer cells have altered dielectric properties compared with normal cells, thereby distorting the local electrical field. The induced changes in capacitance and conductivity are measurable using EIS. We evaluated EIS in demonstrating the cause of lymph node enlargement. 51 lymph nodes that were suspicious for malignancy on ultrasound (32 patients, mean age 32 years), with a mean size of 18 mm x 12 mm x 10 mm, were examined. The following lymph node locations were included in the study: cervical, inframandibular, axillary, paraaortic and inguinal. EIS results were compared with histopathological and follow-up findings. 30/34 malignant lymph nodes were correctly detected using EIS, while 14/17 inflammatory or benign lymph nodes were correctly identified as benign by EIS; thus, there were 4/51 false negative and 3/51 false positive cases. The sensitivity was 88.2% and the specificity was 82.4%. Corresponding negative and positive predictive values were 77.8% and 90.9%, respectively. Results from this initial study suggest the potential usefulness of EIS as an adjunctive imaging modality in the differentiation of lymphadenopathy that is equivocal on ultrasound. The best accuracy was obtained in the cervical, axillary and inguinal regions. Owing to technical restrictions of the present system, examination of inframandibular and paraaortic lymph nodes should be limited to special cases.

Adult↗

PubMed1981

Anatomical considerations in suprahilar lymph node dissection for testicular tumors.

To evaluate the usefulness of removing lymph nodes located above the renal vessels in men with nonseminomatous testicular cancer we have: (1) reviewed the anatomy of the testicular lymphatic drainage; (2) analyzed data on 30 suprahilar lymph node dissections, and (3) reviewed 19 CT scans on patients with testicular cancer. Because the primary lymphatic drainage of the testis is not to suprahilar nodes, in the absence of bulky disease these lymph nodes rarely contain metastatic disease. Furthermore, because most suprahilar lymph nodes are located behind the aorta in between the crura of the diaphragm these lymph nodes are difficult, if not impossible, to resect. Thus, in patients without lymph node enlargement, suprahilar extension of routine lymphadenectomies is not recommended.

Humans↗

PubMed1992

Postoperative radiotherapy in head and neck carcinoma with extracapsular lymph node extension and/or positive resection margins: a comparative study.

In head and neck carcinoma, the finding of extracapsular lymph node extension and/or positive resection margins portends poor locoregional control and survival. The effectiveness of postoperative radiotherapy in these patients has been controversial due to insufficient studies comparing resected patients with those also receiving radiation. Between 1982 and 1988, 441 radical head and neck resections were performed at the Medical College of Virginia. Pathologic review of these cases identified 125 with extracapsular lymph node extension and/or positive resection margins. Of these, 43 had extracapsular lymph node extension only, 24 had both positive resection margins and extracapsular lymph node extension, and 58 demonstrated positive resection margins only. Surgery alone was performed in 71 of these patients while 54 cases received surgery and postoperative radiotherapy, (combined modality treatment) CMT. Radiotherapy doses ranged from 50 to 70 Gy. The surgery alone and combined modality treatment groups were comparable with respect to the distribution of positive resection margins and extracapsular lymph node extension. Slightly more CMT patients had clinical T4 disease compared with the surgery alone group (22% vs 14%). Slightly fewer combined modality treatment patients had clinical N0 necks than the surgery alone group (20% vs 29%). Multivariate analysis was performed with the variables T, N stages, radiotherapy, margin status, primary tumor sites, microscopic and macroscopic extracapsular lymph node extension, number of positive lymph nodes, number of nodes with extracapsular lymph node extension. Locoregional control was maintained at 5 years in 59% of the combined modality treatment group and 31% of the surgery alone group (p.0001). Subgroup analysis likewise reveals significant differences favoring the combined modality treatment group for positive resection margins only (49% vs 41%; p = .04), extracapsular lymph node extension only (66% vs 31%; p = .03) and extracapsular lymph node extension+positive resection margins (68% vs 0%; p = .001). Adjusted survival also shows a significant benefit of combined modality treatment vs surgery alone for the entire group (72% vs 41%; p = .001). Multivariate analysis revealed that the use of radiotherapy is a strongly favorable variable for local control and adjusted survival. Macroscopic extracapsular lymph node penetration and positive resection margins are unfavorable independent variables for local control. T-stage is the only variable predicting local control in the combined modality group. Extracapsular extension remains an important negative prognostic variable for survival in both treatment groups. In conclusion, this study demonstrates a locoregional control and survival benefit for postoperative radiotherapy in patients with the high risk pathologic findings of extracapsular lymph node extension and positive resection margins.

Carcinoma, Squamous Cell↗

PubMed2000

When is pelvic lymph node dissection necessary before radical prostatectomy? A decision analysis.

PURPOSE: In recent years the role of pelvic lymph node dissection before or at radical prostatectomy has been questioned. We compared the outcome of performing or omitting pelvic lymph node dissection in patients undergoing radical retropubic prostatectomy by formal decision analysis. MATERIALS AND METHODS: We created a decision tree for patients undergoing radical retropubic prostatectomy that accounts for all possible branch points and outcomes. Outcome probabilities applied to the model were derived from published data. Utility values were determined for each outcome state by a panel of experts. Decision analysis was done using decision analysis computer software. Sensitivity analysis was performed to determine which elements in the model were most important and to calculate threshold values. RESULTS: Using probability data from the literature and our assigned outcome values, decision analysis initially favored omitting pelvic lymph node dissection. Sensitivity analysis revealed that the threshold values for the incidence of positive lymph nodes and the sensitivity of lymph node dissection and frozen section analysis at which outcomes were equivalent were 18% and 80%, respectively. Analysis was insensitive to the pelvic lymph node dissection complication rate. CONCLUSIONS: We performed formal decision analysis to determine the incidence of lymph node metastasis below which pelvic lymph node dissection is not warranted at radical retropubic prostatectomy. Our results suggest that lymph node dissection is unnecessary in the subset of patients in which the risk of lymph node involvement is less than 18%.

Decision Support Techniques↗

PubMed2001

Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection.

OBJECTIVE: To assess the status of the regional and paraaortic lymph nodes in hilar cholangiocarcinoma and to clarify the efficacy of systematic extended lymphadenectomy. SUMMARY BACKGROUND DATA: There have been no studies in which regional and paraaortic lymphadenectomies for hilar cholangiocarcinoma have been routinely performed. Therefore, the metastasis rates to the regional and paraaortic nodes, the mode of lymphatic spread, and the effect of extended lymph node dissection on survival remain unknown. METHODS: This study involved 110 patients who underwent surgical resection for hilar cholangiocarcinoma with lymph node dissection including both the regional and paraaortic nodes. A total of 2,652 nodes retrieved from the surgical specimens were examined microscopically. RESULTS: Of the 110 patients, 52 (47.3%) had no involved nodes, 39 (35.5%) had regional lymph node metastases, and 19 (17.3%) had regional and paraaortic node metastases. The incidence of positive nodes was significantly higher in the patients with pT3 disease than in those with pT2 disease. The pericholedochal nodes were most commonly involved (42.7%), followed by the periportal nodes (30.9%), the common hepatic nodes (27.3%), and the posterior pancreaticoduodenal nodes (14.5%). The celiac and superior mesenteric nodes were rarely involved. The 3-year and 5-year survival rates were 55.4% and 30.5% for the 52 patients without involved nodes, 31.8% and 14.7% for the 39 patients with regional node metastases, and 12.3% and 12.3% for the 19 patients with paraaortic node metastases, respectively. Of the 19 patients with positive paraaortic nodes, 7 had no macroscopic evidence of paraaortic disease on intraoperative inspection. The survival in this group was significantly better than in the remaining 12 patients. CONCLUSION: The paraaortic nodes and the regional nodes are frequently involved in advanced hilar cholangiocarcinoma. Whether extended lymph node dissection provides a survival benefit requires further study. However, the fact that long-term survival is possible despite pN2 or pM1 disease encourages the authors to perform an aggressive surgical procedure with extended lymph node dissection in selected patients with hilar cholangiocarcinoma.

Aorta↗