Refining oncological resectability for intrahepatic cholangiocarcinoma: Radiological assessment of mediastinal lymph node enlargement does not reflect clinical prognosis after curative resection

INTRODUCTION: With advances in surgical techniques, resectability of intrahepatic cholangiocarcinoma (ICCA) is now largely determined by oncological criteria. Distinguishing localized disease from early systemic spread remains a major challenge in interdisciplinary decision-making. This study aimed to evaluate the prognostic significance of radiologically enlarged mediastinal lymph nodes (emLN) in patients with resectable ICCA. MATERIALS AND METHODS: Clinical data from all consecutive patients who underwent liver resection for ICCA between 2008 and 2018 at a single high-volume center were prospectively collected, with outcome data supplemented retrospectively. RESULTS: A total of 109 patients met the inclusion criteria and comprised the study cohort. Cross-sectional imaging identified emLN in 48 patients (44 %). Overall survival (OS) and recurrence-free survival (RFS) did not differ significantly between patients with and without emLN (OS: 29 vs. 30 months, p = 0.55; RFS: 11 months in both groups, p = 0.63). Among patients with left-sided ICCA, emLN were present in 39 cases (79.6 %), compared with 33 cases (55.0 %) in patients with right-lobe tumors (p = 0.008). CONCLUSION: This is the first study to assess the potential prognostic impact of radiologically enlarged mediastinal lymph nodes in ICCA. The presence of emLN on preoperative staging was not associated with impaired survival outcomes. Therefore, patients with resectable ICCA should be considered for curative resection irrespective of this radiological finding.