CASCADE OF METASTATIC COLORECTAL-CARCINOMA FROM THE LIVER TO THE ANTERIOR DIAPHRAGMATIC LYMPH-NODES

Rationale and Objectives. Metastases of colon carcinoma from the liver to porta hepatis and celiac axis lymph nodes constitute a contraindic ation to hepatic metastatic resection. Our objective was to determine the frequency of anterior diaphragmatic lymph node (ADLN) enlargement, another efferent pathway of hepatic lymphatic drainage, in patients w ith colon carcinoma. Methods. Abdominal computed tomography scans from 50 patients with colon carcinoma in whom hepatic metastases were eith er present (n = 25) or absent (n = 25) were reviewed. ADLNs greater th an or equal to 5 mm were considered enlarged.Results. Thirteen of 25 p ateints with hepatic metastases had ADLNs greater than or equal to 5 m m; three of 25 patients without hepatic metastases had ADLNs greater t han or equal to 5 mm. The difference was statistically significant (p = .002). Conclusion. Metastases of colon carcinoma from the liver to t he ADLNs probably are not rare. ADLN nvolvement would obviate hepatic resection. The ADLNs should be assessed preoperatively in surgical can didates with hepatic metastases of colon carcinoma.