Surgery, Gastroenterology and Oncology

Even though lymph node status is one of the most important predictors of survival for patients undergoing curative-intent surgery for peri-hilar cholangiocarcinoma (PHCC), the optimal lymph node staging system for PHCC has not been identified.
Recently, the newly published 8th edition of the American Joint Committee on Cancer (AJCC) staging system reformed the criteria used to stage the lymph node status of PHCC patients but this change did not demonstrate to significantly improve the prognostic stratification of patients with PHCC. Among the several clinical tools that have been proposed in replacement of the AJCC N stages, the lymph node ratio (LNR) defined as the ratio of the number of metastatic lymph nodes to the number of lymph nodes harvested, demonstrated to improve the lymph node staging of patients with several gastrointestinal and hepatobiliary cancers.
When tested in PHCC patients, while LNR was associated with patientsâ?? prognosis, the prognostic performances of LNR were strongly influenced by the number of lymph node harvested suggesting that LNR might be of less clinical value in PHCC patients due to the relatively small number of lymph node harvested compared with other gastrointestinal cancers.
While other clinical tool (i.e. LODDS) has been proposed to assess lymph node status, further studies are needed to improve the lymph nodal staging of PHCC patients.

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