Clockwise Anterior-to-Posterior-Double Isolation (CAP-DI) Approach for Portal Lymphadenectomy in Biliary Tract Cancer: Technique, Yield, and Outcomes.
Andrew J SinnamonEric LuoAileen XuSarah ZhuJason W DenboJason B FlemingDaniel A AnayaPublished in: Cancers (2022)
Background: Portal lymphadenectomy (PLND) is the current standard for oncologic resection of biliary tract cancers (BTCs). However, published data show it is performed infrequently and often yields less than the recommended 6 lymph nodes. We sought to identify yield and outcomes using a Clockwise Anterior-to-Posterior technique with Double Isolation of critical structures (CAP-DI) for PLND. Methods: Consecutive patients undergoing complete PLND for BTCs using CAP-DI technique were identified (2015−2021). Lymph node (LN) yield and predictors of LN count were examined. Secondary outcomes included intraoperative and postoperative outcomes, which were compared to patients having hepatectomy without PLND. Results: In total, 534 patients were included; 71 with complete PLND (36 gallbladder cancers, 24 intrahepatic cholangiocarcinomas, 11 perihilar cholangiocarcinomas) and 463 in the control group. The median PLND yield was 5 (IQR 3−8; range 0−17) and 46% had at least 6 nodes retrieved. Older age was associated with lower likelihood of ≥6 node PLND yield (p = 0.032), which remained significant in bivariate analyses with other covariates (p < 0.05). After adjustment for operative factors, performance of complete PLND was independently associated with longer operative time (+46.4 min, p = 0.001), but no differences were observed in intraoperative or postoperative outcomes compared to the control group (p > 0.05). Conclusions: Yield following PLND frequently falls below the recommended minimum threshold of 6 nodes despite a standardized stepwise approach to complete clearance. Older age may be weakly associated with lower PLND yield. While all efforts should be made for complete node retrieval, failure to obtain 6 nodes may be an unrealistic metric of surgical quality.
Keyphrases
- lymph node
- patients undergoing
- sentinel lymph node
- end stage renal disease
- ejection fraction
- chronic kidney disease
- newly diagnosed
- early stage
- neoadjuvant chemotherapy
- peritoneal dialysis
- type diabetes
- squamous cell carcinoma
- prostate cancer
- physical activity
- lymph node metastasis
- biofilm formation
- young adults
- adipose tissue
- cystic fibrosis
- quality improvement
- metabolic syndrome
- machine learning
- randomized controlled trial
- weight loss
- middle aged
- skeletal muscle
- systematic review
- minimally invasive
- artificial intelligence
- big data