Is Para-aortic Lymph Node Metastasis a Contraindication for Radical Resection in Biliary Carcinoma?

Para-aortic nodal dissection in patients with biliary carcinoma has not been performed routinely worldwide. Therefore, the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma has not yet been evaluated. The aim of this study was to clarify the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma. Of 113 patients with biliary adenocarcinoma who underwent surgical resection with regional and para-aortic lymph node dissection, para-aortic lymph node metastasis was found in 17 patients (15%) by final pathological examination. Relationships between clinicopathological factors, including para-aortic lymph node metastasis, and survival were analyzed by univariate and multivariate analyses. Overall survival rates for the 113 patients were 82% at 1 year, 65% at 2 years, 58% at 3 years, and 52% at 5 years. Univariate analysis revealed that better tumor differentiation (P = 0.044), negative lymph node metastasis (P < 0.001), negative para-aortic lymph node metastasis (P = 0.007), negative surgical margin status (P < 0.001), lower UICC pT factor (P = 0.009), and earlier UICC stage (P < 0.001) were associated significantly with longer survival. Lymph node metastasis (P = 0.004) but not para-aortic lymph node metastasis (P = 0.323) remained associated independently with longer survival by multivariate analysis. Five-year survival rates for node-negative patients, node-positive patients without para-aortic lymph node metastasis, and node-positive patients with para-aortic lymph node metastasis were 72, 31, and 24%, respectively. Radical resection should not be abandoned for patients with para-aortic lymph node metastasis in biliary adenocarcinoma.