Effects And Significance Of Different Dissection Methods On The Number Of Harvested Lymph Nodes And Prognosis Of Patients With Intrahepatic Cholangiocarcinoma

Objective:To study the effects of different lymph node dissection methods on the number of harvested lymph nodes and prognosis of patients with intrahepatic cholangiocarcinoma.Methods:To retrospectively analyze the clinical data of 57 cases of intrahepatic cholangiocarcinoma treated by surgical in our Hospital from January 2011 to January2016.All of the patients were divided into 2 groups according to the different surgical methods.Radical surgical resection and whole block fusion dissection group(A group,36 cases).Radical surgical resection and conventional dissection group(group B,21cases).The preoperative general conditions,operative time,intraoperative blood loss,intraoperative hepatic portal occlusion,postoperative complications,pathological examination,postoperative survival time and other clinical indicators of the two groups were recorded and compared by statistical analysis.Results:All patients were successfully operated.While ensuring the radical surgiacl resection of the tumor,All the 36 patients in group A completed the whole block fusion dissection,and all the 21 patients in group B completed the conventional dissection.(1)The preoperative general data of the 2 groups were compared without statistical difference(P>0.05).(2)The intraoperative conditions of the two groups were compared.In group A,the operative time,number of liver resection segments(>3,?3),intraoperative blood loss,hepatic portal occlusion time were(266.46±24.11)min,31 and 5 cases,(217.78±52.60)mL,(20.83±9.21)min,respectively.In group B,the above indexes were(269.90±22.75)min,19 and 2cases,(207.14±45.29)mL,(19.43±7.63)min,respectively,All the above indicators were compared between the two groups,and the difference was not statistically significant(t=-0.530,0.774,0.590,?~2=0.004,P>0.05).(3)The Postoperative pathological examination results of the two groups were compared.The average number of harvested lymph nodes,the percentage of positive lymph nodes of the A group were(11±3),16.6%(66/398),respectively,versus(5±2),6.8%(7/103)of the B group,and the differences between the two groups was statistically significant(t=-9.454,2.148,P<0.05).(4)The data of 2 groups were compared during postoperative complications.Clavien-Dindo grade I~II class,Clavien-Dindo grade III~V class,delayed gastric emptying,postoperative hemorrhage,incision infection,bile leakage were respectively 35,1,0,1,8,6 in the A group and 19,2,1,1,2,3 in the B group,and with no difference between the two groups(?~2=0.236,0.000,1.870,P>0.05).(5)57 patients were followed up for 5-42 months,with a median time of 36 months.The survival time and postoperative 3-year survival rate were respectively 36 months(range,8-42 months)and 66.7%of the A group,versus 23 months(range,5-39 months)and 38.1%of the B group,showing significant differences in the above indicators between the two groups(Z=-2.253,?~2=5.317,P<0.05).Conclusion:.For patients with intrahepatic cholangiocarcinoma,the method of the whole block fusion dissection is not only conducive to increasing the number of postoperative lymph node examination,improve the postoperative survival of patients,but also can formulating more accurate and individualized postoperative adjuvant treatment programs according to the pathological staging of patients.