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The outcome of liver resection and lymphadenectomy for hilar lymph node involvement in colorectal cancer liver metastases

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Abstract

Objective

Hepatic hilar lymph node (HLN) involvement is considered as a poor prognostic factor during liver resection in colorectal liver metastases (CLM). The purpose of this study is to identify the clinical factors that distinguish HLN-positive patients from those who are hilar lymph node negative and to evaluate the frequency of macroscopic involvement of hepatic HLN, to investigate the impact of HLN involvement on survival after resection for CLM with lymphadenectomy and adjuvant chemotherapy.

Patients and methods

Between January 2000 and August 2012, 73 selected CLM patients underwent liver resections with lymphadenectomy in the Hepatopancreatobiliary Surgery Department I of Beijing Cancer Hospital. Clinical data, surgical outcome, and prognosis after operation of patients with HLN involvement were compared with that of patients without HLN involvement.

Results

Of the 73 patients who underwent liver resections with lymphadenectomy, 12 (16.4 %) patients had HLN involvement identified by pathology. Compared with patients without HLN involvement, the frequency of lymph nodes metastasis for primary tumor was significantly higher in HLN-positive patients (p = 0.023). For CLM patients with and without HLN involvement, 5-year overall survival (OS) was 16.2 and 37.1 %, respectively (p = 0.04). Five-year disease-free survival (DFS) rates were 0 and 32.9 % (p = 0.034). Multivariate analysis showed that involved resected HLN was an independent risk factor for overall survival.

Conclusion

We should suspect HLN involvement in patients with colorectal cancer liver metastases when they have regional lymph nodes of primary tumor metastasis. Liver resection with HLN dissection might offer a unique curative opportunity for CLM patients with HLN involvement.

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References

  1. Thelen A, Jonas S, Benckert C et al (2007) Repeat liver resection for recurrent liver metastases from colorectal cancer [J]. Eur J Surg Oncol 33(3):324–328

    Article  CAS  PubMed  Google Scholar 

  2. Sharma S, Camci C, Jabbour N (2008) Management of hepatic metastasis from colorectal cancers: an update [J]. J Hepatobiliary Pancreat Surg 15(6):570–580

    Article  PubMed  Google Scholar 

  3. Elias D, Youssef O, Sideris L et al (2004) Evolution of missing colorectal liver metastases following inductive chemotherapy and hepatectomy [J]. J Surg Oncol 86(1):4–9

    Article  PubMed  Google Scholar 

  4. Kelly C, Cassidy J (2007) Chemotherapy in metastatic colorectal cancer [J]. Surg Oncol 16(1):65–70

    Article  PubMed  Google Scholar 

  5. Chang AE, Schneider PD, Sugarbaker PH et al (1987) A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases [J]. Ann Surg 206(6):685–693

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Cunningham D, Pyrhonen S, James RD et al (1998) Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer[J]. Lancet 352(9138):1413–1418

    Article  CAS  PubMed  Google Scholar 

  7. Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases[J]. Ann Surg 239(6):818–825, 825-827

    Article  PubMed Central  PubMed  Google Scholar 

  8. Fernandez FG, Drebin JA, Linehan DC et al (2004) Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET) [J]. Ann Surg 240(3):438–447, 447-450

    Article  PubMed Central  PubMed  Google Scholar 

  9. August DA, Sugarbaker PH, Schneider PD (1985) Lymphatic dissemination of hepatic metastases. Implications for the follow-up and treatment of patients with colorectal cancer[ J]. Cancer 55(7):1490–1494

    Article  CAS  PubMed  Google Scholar 

  10. Hughes K, Scheele J, Sugarbaker PH (1989) Surgery for colorectal cancer metastatic to the liver. Optimizing the results of treatment [J]. Surg Clin North Am 69(2):339–359

    CAS  PubMed  Google Scholar 

  11. Dworkin MJ, Earlam S, Fordy C et al (1995) Importance of hepatic artery node involvement in patients with colorectal liver metastases [J]. J Clin Pathol 48(3):270–272

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Abdalla EK, Adam R, Bilchik AJ et al (2006) Improving resectability of hepatic colorectal metastases: expert consensus statement [J]. Ann Surg Oncol 13(10):1271–1280

    Article  PubMed  Google Scholar 

  13. Laurent C, Sa CA, Rullier E et al (2004) Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis[J]. J Am Coll Surg 198(6):884–891

    Article  PubMed  Google Scholar 

  14. Elias DM, Ouellet JF (2003) Incidence, distribution, and significance of hilar lymph node metastases in hepatic colorectal metastases [J]. Surg Oncol Clin N Am 12(1):221–229

    Article  PubMed  Google Scholar 

  15. Kokudo N, Sato T, Seki M et al (1999) Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer [J]. Dis Colon Rectum 42(10):1285–1290, 1290-1291

    Article  CAS  PubMed  Google Scholar 

  16. Jaeck D, Oussoultzoglou E, Rosso E (2007) Hepatectomy for colorectal metastases in the presence of extrahepatic disease[J]. Surg Oncol Clin N Am 16(3):507–523

    Article  PubMed  Google Scholar 

  17. Oussoultzoglou E, Romain B, Panaro F et al (2009) Long-term survival after liver resection for colorectal liver metastases in patients with hepatic pedicle lymph nodes involvement in the era of new chemotherapy regimens[J]. Ann Surg 249(6):879–886

    Article  PubMed  Google Scholar 

  18. Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver [J]. World J Surg 6(1):3–9

    Article  CAS  PubMed  Google Scholar 

  19. Labianca R, Nordlinger B, Beretta GD et al (2010) Primary colon cancer: ESMO clinical practice guidelines for diagnosis, adjuvant treatment and follow-up [J]. Ann Oncol 21(Suppl 5):v70–v77

    Article  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey [J]. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  21. Rau C, Blanc B, Ronot M et al (2012) Neither preoperative computed tomography nor intra-operative examination can predict metastatic lymph node in the hepatic pedicle in patients with colorectal liver metastasis [J]. Ann Surg Oncol 19(1):163–168

    Article  PubMed  Google Scholar 

  22. Dighe S, Blake H, Koh MD et al (2010) Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer [J]. Br J Surg 97(9):1407–1415

    Article  CAS  PubMed  Google Scholar 

  23. Bellomi M, Bonomo G, Landoni F et al (2005) Accuracy of computed tomography and magnetic resonance imaging in the detection of lymph node involvement in cervix carcinoma [J]. Eur Radiol 15(12):2469–2474

    Article  PubMed  Google Scholar 

  24. Kato H, Kuwano H, Nakajima M et al (2002) Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma [J]. Cancer 94(4):921–928

    Article  PubMed  Google Scholar 

  25. Koh DM, Hughes M, Husband JE (2006) Cross-sectional imaging of nodal metastases in the abdomen and pelvis [J]. Abdom Imaging 31(6):632–643

    Article  CAS  PubMed  Google Scholar 

  26. Grobmyer SR, Wang L, Gonen M et al (2006) Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy [J]. Ann Surg 244(2):260–264

    Article  PubMed Central  PubMed  Google Scholar 

  27. Jaeck D, Nakano H, Bachellier P et al (2002) Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study [J]. Ann Surg Oncol 9(5):430–438

    Article  PubMed  Google Scholar 

  28. Nakamura S, Suzuki S, Konno H (1999) Resection of hepatic metastases of colorectal carcinoma: 20 years experience [J]. J Hepatobiliary Pancreat Surg 6(1):16–22

    Article  CAS  PubMed  Google Scholar 

  29. Imamura H, Matsuyama Y, Shimada R et al (2001) A study of factors influencing prognosis after resection of hepatic metastases from colorectal and gastric carcinoma [J]. Am J Gastroenterol 96(11):3178–3184

    Article  CAS  PubMed  Google Scholar 

  30. Iwatsuki S, Dvorchik I, Madariaga JR et al (1999) Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system [J]. J Am Coll Surg 189(3):291–299

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Kemeny N, Jarnagin W, Paty P et al (2005) Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer [J]. J Clin Oncol 23(22):4888–4896

    Article  CAS  PubMed  Google Scholar 

  32. Bennett JJ, Cao D, Posner MC (2005) Determinants of unresectability and outcome of patients with occult colorectal hepatic metastases [J]. J Surg Oncol 92(1):64–69

    Article  PubMed  Google Scholar 

  33. Irie T, Itai Y, Hatsuse K et al (1999) Does resection of small liver metastases from colorectal cancer improve survival of patients? [J]. Br J Radiol 72(855):246–249

    CAS  PubMed  Google Scholar 

  34. Adam R, de Haas RJ, Wicherts DA et al (2008) Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? [J]. J Clin Oncol 26(22):3672–3680

    Article  PubMed  Google Scholar 

  35. Ishibashi K, Ohsawa T, Yokoyama M et al (2006) Hepatic lymph node involvement in patients with synchronous multiple liver metastases of colorectal cancer [J]. Gan To Kagaku Ryoho 33(12):1834–1837

    PubMed  Google Scholar 

  36. Carpizo DR, D'Angelica M (2009) Liver resection for metastatic colorectal cancer in the presence of extrahepatic disease [J]. Ann Surg Oncol 16(9):2411–2421

    Article  PubMed  Google Scholar 

  37. Ercolani G, Grazi GL, Ravaioli M et al (2004) The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy [J]. Ann Surg 239(2):202–209

    Article  PubMed Central  PubMed  Google Scholar 

  38. Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1,001 consecutive cases [J]. Ann Surg 230(3):309–318, 318-321

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Rodgers MS, Mccall JL (2000) Surgery for colorectal liver metastases with hepatic lymph node involvement: a systematic review [J]. Br J Surg 87(9):1142–1155

    Article  CAS  PubMed  Google Scholar 

  40. Elias D, Saric J, Jaeck D et al (1996) Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases [J]. Br J Surg 83(7):942–945

    Article  CAS  PubMed  Google Scholar 

  41. Jaeck D (2003) The significance of hepatic pedicle lymph nodes metastases in surgical management of colorectal liver metastases and of other liver malignancies [J]. Ann Surg Oncol 10(9):1007–1011

    Article  PubMed  Google Scholar 

  42. Zacharias T, Jaeck D, Oussoultzoglou E et al (2004) First and repeat resection of colorectal liver metastases in elderly patients [J]. Ann Surg 240(5):858–865

    Article  PubMed Central  PubMed  Google Scholar 

  43. Jaeck D, Oussoultzoglou E, Rosso E et al (2004) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases [J]. Ann Surg 240(6):1037–1049, 1049-1051

    Article  PubMed Central  PubMed  Google Scholar 

  44. Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival [J]. Ann Surg 240(4):644–657, 657-658

    PubMed Central  PubMed  Google Scholar 

  45. Nordlinger B, Vauthey JN, Poston G et al (2010) The timing of chemotherapy and surgery for the treatment of colorectal liver metastases [J]. Clin Colorectal Cancer 9(4):212–218

    Article  CAS  PubMed  Google Scholar 

  46. Andre T, Boni C, Mounedji-Boudiaf L et al (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer [J]. N Engl J Med 350(23):2343–2351

    Article  CAS  PubMed  Google Scholar 

  47. de Jong MC, Pulitano C, Ribero D et al (2009) Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients [J]. Ann Surg 250(3):440–448

    PubMed  Google Scholar 

  48. Figueras J, Torras J, Valls C et al (2007) Surgical resection of colorectal liver metastases in patients with expanded indications: a single-center experience with 501 patients [J]. Dis Colon Rectum 50(4):478–488

    Article  PubMed  Google Scholar 

  49. Parks R, Gonen M, Kemeny N et al (2007) Adjuvant chemotherapy improves survival after resection of hepatic colorectal metastases: analysis of data from two continents [J]. J Am Coll Surg 204(5):753–761, 761-763

    Article  PubMed  Google Scholar 

  50. Abdalla EK, Bauer TW, Chun YS et al (2013) Locoregional surgical and interventional therapies for advanced colorectal cancer liver metastases: expert consensus statements [J]. HPB (Oxford) 15(2):119–130

    Article  Google Scholar 

  51. Townsend A, Price T, Karapetis C (2009) Selective internal radiation therapy for liver metastases from colorectal cancer [J]. Cochrane Database Syst Rev 4:D7045

    Google Scholar 

  52. Kim K, Chie EK, Kim W et al (2010) Absence of symptom and intact liver function are positive prognosticators for patients undergoing radiotherapy for lymph node metastasis from hepatocellular carcinoma [J]. Int J Radiat Oncol Biol Phys 78(3):729–734

    Article  PubMed  Google Scholar 

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Conflicts of interest and ethical adherence

The authors do not have any conflict of interest. The authors assure that the protocol for the research project has been approved by the Ethics Committee of the Beijing Cancer Hospital.

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Authors and Affiliations

  1. Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, No. 52, Fu-Cheng-Lu Street, Beijing, 100142, People’s Republic of China

    Wei Liu, Xiao-Luan Yan, Kun Wang, Quan Bao, Yi Sun & Bao-Cai Xing

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  1. Wei Liu
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  2. Xiao-Luan Yan
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  3. Kun Wang
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Correspondence to Bao-Cai Xing.

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Liu, W., Yan, XL., Wang, K. et al. The outcome of liver resection and lymphadenectomy for hilar lymph node involvement in colorectal cancer liver metastases. Int J Colorectal Dis 29, 737–745 (2014). https://doi.org/10.1007/s00384-014-1863-5

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