Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases

Abstract

Infiltration of lymph nodes in the hepatoduodenal ligament is the most important prognostic factor following R0 resection of colorectal liver metastases.

Simplified Staging System for Predicting the Prognosis of Patients With Resectable Liver Metastasis

“…[22][23][24][25][26][27][28] Although hepatectomy and lymph node dissection were performed in these patients, 5-year survival was reportedly 0% to 5%. 24,25,28 Rodgers and McCall 29 reviewed 15 studies that gave survival data on node-positive patients: 145 patients received hepatic resection, and only 5 (3.4%) survived 5 years. Based on these findings together with the present results, patients with hepatic lymph node metastasis were assigned to stage 4 in the simplified staging system.…”

The role of hilar lymphadenectomy in patients subjected to hepatectomy due to colorectal metastasis

“…Based on these findings, the authors concluded that this sampling method is effective for determining the lymph node status of a patient. However, other authors have not found a relationship between the chains involved and the topography of the hepatic lesions (7,11,17,20) . In 1996, Elias et al (11) diagnosed microscopic lymph-node involvement in several of the lymphatic chains studied without a continuous progression from one chain to another (lymph-node-jumping metastasis).…”

“…Among those results, Kokudo et al (19) have shown that the survival rate of patients with lymph node disease who undergo curative resection and lymphadenectomy is significantly higher than that of residual-liver-disease patients without lymph-node metastases who undergo liver resection (17 months versus 8 months, P<0.05). These authors therefore suggest a possible benefit from resection and hilar lymphadenectomy in patients with lymph node involvement (7) . Two other studies have found 3-year survival rates between 38% and 45% in patients with compromised liver pedicle lymph nodes who undergo liver resection combined with lymphadenectomy.…”

“…It is believed that lymph-node involvement in patients with colorectal liver metastases may actually constitute a tertiary metastasis or ''metastasis of a metastasis'', a concept proposed by August et al (6) in 1985 and subsequently reinforced by other studies (10,15) . The prevalence of macroscopic lymph node involvement in the hepatic hilum of patients with colorectal liver metastases varies between 2% and 10% in major series (6,7,12,29) , and they generally indicate a poor long-term prognosis. Based on these results, most authors have considered macroscopic lymph node involvement to be a contraindication to liver resection (13,22,32) .…”

“…Despite a certain amount of controversy, some authors have reported significant survival rates in liver-metastasis patients with associated hilar-lymph-node disease who undergo combined liver resection and lymphadenectomy (7,9,16,17,25) . Among those results, Kokudo et al (19) have shown that the survival rate of patients with lymph node disease who undergo curative resection and lymphadenectomy is significantly higher than that of residual-liver-disease patients without lymph-node metastases who undergo liver resection (17 months versus 8 months, P<0.05).…”