Abstract
Routine regional lymphadenectomy for colorectal liver metastases and primary liver tumors is still a subject for debate. During 2001–2005, we performed a prospective study of cases in which regional lymphadenectomy around the hepato-duodenal ligament and common hepatic artery was applied (group R+ LN) or not (group R− LN). Pre-operative clinical features of patients were comparable among groups as well as the operative data. There were 108 (67%) males; the median age was 66 years; 124 cases had a single lesion (77%), and the median diameter was 4 cm. The type of lesion was: 77 (48%) colorectal liver metastases (M-CR), 75 (46%) hepatocellular carcinomas (HCC) and 10 (6%) cholangiocellular carcinomas. In the R+ LN group, the mean number of lymph nodes removed was 6.7 ± 4.8 (range 4–26), and seven cases (8.6%) presented lymph node metastasis. The median follow-up was 3.5 years. M-CR patients showed comparable hospital mortality (R+ LN 0% vs. R− LN 2.6%) and morbidity (R+ LN 17.9% vs. R− LN 21.1%), but R+ LN had higher 5-year disease-free survival (31 vs. 16%, p < 0.05). HCC cases in the R+ LN group presented higher hospital mortality (13.5 vs. 0%, p < 0.05) without any improvement in disease-free survival (it was at 5-year disease-free survival 34 vs. 33%, respectively, p = n.s.). Routine regional lymphadenectomy should be performed for colorectal liver metastases, and avoided in patients with hepatocellular carcinoma.
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Jaeck D, Oussoultzoglou E (2007) Intrahepatic lymphatic invasion independently predicts poor survival and recurrences after hepatectomy in patients with colorectal carcinoma liver metastases. Ann Surg Oncol 14:3297–3298
Jaeck D (2003) The significance of hepatic pedicle lymph nodes metastases in surgical management of colorectal liver metastases and of other liver malignancies. Ann Surg Oncol 10:1007–1011
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 Clin Oncol 26:3672–3680
Sakaguchi T, Suzuki S, Nakamura S et al (2006) Role of node dissection for lymphatic remetastasis in repeat hepatectomy for colorectal liver metastasis. Dig Surg 23:80–85
Rosen CB, Nagorney DM, Taswell HF et al (1992) Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 216:493–505
Iwatsuki S, Dvorchik I, Madariaga JR et al (1999) Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg 189:291–299
Shimada H, Endo I, Togo S et al (1997) The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 79:892–899
Kitagawa Y, Nagino M, Kamiya J et al (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233:385–392
Ercolani G, Grazi GL, Ravaioli M et al (2004) The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg 239:202–209
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. Ann Surg Oncol 9:430–438
Grobmyer SR, Wang L, Gonen M et al (2006) Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy. Ann Surg 244:260–264
Grazi GL, Ercolani G, Pierangeli F et al (2001) Improved results of liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value. Ann Surg 234:71–78
Ercolani G, Ravaioli M, Grazi GL et al (2008) Use of vascular clamping in hepatic surgery: lessons learned from 1260 liver resections. Arch Surg 143:380–388
Cucchetti A, Ercolani G, Vivarelli M et al (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971
Del Gaudio M, Ercolani G, Ravaioli M et al (2008) Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience. Am J Transplant 8:1177–1185
Ravaioli M, Grazi GL, Principe A et al (2003) Operative risk by the lidocaine test (MEGX) in resected patients for HCC on cirrhosis. Hepatogastroenterology 50:1552–1555
Gurusamy KS, Imber C, Davidson BR (2008) Management of the hepatic lymph nodes during resection of liver metastases from colorectal cancer: a systematic review. HPB Surg 2008:684150
Garden OJ, Rees M, Poston GJ et al (2006) Guidelines for resection of colorectal cancer liver metastases. Gut 55(Suppl 3):iii1–iii8
O’Rourke TR, Tekkis P, Yeung S et al (2008) Long-term results of liver resection for non-colorectal, non-neuroendocrine metastases. Ann Surg Oncol 15:207–218
Goéré D, Elias D (2008) Resection of liver metastases from non-colorectal non-endocrine primary tumours. Eur J Surg Oncol 34:281–288
Shimada S, Yamashita Y, Aishima S et al (2001) Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma. Br J Surg 88:1463–1466
Rassi E, Partensky C, Scoazec JY et al (1999) Peripheral cholangiocarcinoma: presentation, diagnosis, pathology and management. Eur J Surg Oncol 25:375–380
Bennett JJ, Schmidt CR, Klimstra DS et al (2008) Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases. Ann Surg Oncol 15:1130–1136
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Ravaioli, M., Ercolani, G., Grazi, G.L. et al. Safety and prognostic role of regional lymphadenectomy for primary and metastatic liver tumors. Updates Surg 62, 27–34 (2010). https://doi.org/10.1007/s13304-010-0008-9
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DOI: https://doi.org/10.1007/s13304-010-0008-9