Routine Lymph Node Dissection in the Surgical Treatment of Primary Liver Tumors: a Systematic Review and Meta-Analysis

Purpose: The incidence of LNM and survival outcomes following routine lymph node dissection (LND) in patients undergoing resection of hepatocellular carcinoma (HCC), intrahepatic- (ICC) and perihilar cholangiocarcinoma (PCC) has not been well-defined. This systematic review and meta-analysis analyzes the incidence of LNM and survival outcomes following routine LND independently of pre-or intraoperative suspicion of LNM following resection of HCC, ICC, and PCC. Methods: The PubMed database was searched from database inception until March, 2025. Random-effects meta-analysis of the incidence of LNM and hazard ratios (HRs) of overall survival (OS) were conducted for each malignancy. Results: Forty studies were included. Routine LND was performed in 5 872 patients. The pooled incidence of LNM following routine LND was 5% among 601 HCC patients, 37% among 2 565 ICC patients, and 39% among 2 706 PCC patients. Presence of LNM was associated with worse OS in ICC (HR: 2.46, 95% CI 1.66–3.65) and PCC (HR: 2.01, 95% CI 1.74–2.33) patients. Conclusion: Routine LND should be performed during resection of ICC and PCC due to the high incidence of LNM and improved survival outcomes, but not during resection of HCC. The presence of LNM gives inferior survival outcomes in ICC and PCC patients.