Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer

PURPOSE: Lymph node metastasis in the hepatoduodenal ligament is known as o ne of the most significant prognostic factors after liver resection for col orectal metastasis. However, there have been very few articles on the clini cal features of node-positive patients and on detailed distribution of posi tive nodes. Further, there has been no established strategy on how to handl e hepatic lymph nodes during liver resection. To address these subjects, a retrospective study was conducted. METHODS: During the period of 1980 throu gh April 1998, 182 hepatic resections were performed for metastatic colorec tal carcinoma. Of these, 78 cases had hepatic lymph node sampling during th e operation. Distribution of positive nodes, location of liver metastasis, stage of the primary lesion, and outcome after liver resection were analyze d. RESULTS: Nine cases (12 percent) had secondary lymph node metastases in the hepatoduodenal ligament. The incidence was slightly higher (13.5 percen t) in the most recent 44 consecutive cases. There was a tendency for liver metastases in the right lobe to metastasize to No. 12b (or node of the fora men of Winslow, lymph nodes along the common bite duct) and liver metastase s in the left lobe to metastasize to No. 8a (anterosuperior group of the ly mph nodes along the common hepatic artery). Outcome of node-positive patien ts (n = 9) was extremely poor (P < 0.001) compared with that of node-negati ve patients (n = Gb), and the most common site of recurrence in the node-po sitive patients was remnant liver and hepatic lymph nodes. Preoperatively, there were no significant predicting factors for positive hepatic lymph nod es. CONCLUSIONS: No. 8a and No. 12b nodes are principal nodes that should b e palpated and sampled during liver resection to check the secondary lympha tic spread from liver metastases. Hepatic nodal involvement indicates the p rogression of disease beyond simple liver metastases and may not be the ind ication for simple surgical removal. Further study, including hepatoduodena l dissection and systemic adjuvant chemotherapy, may elucidate the survival benefit, if any, of liver resection in node-positive patients.