Surgery for colorectal liver metastases with hepatic lymph node involvement: a systematic review

Background: Liver resection for colorectal metastases is the only known tre atment associated with long-term survival; extrahepatic disease is usually considered a contraindication to such treatment. However, some surgeons do not regard spread to the hepatic lymph nodes as a contraindication provided that these nodes can be excised adequately. A systematic review of the lit erature was undertaken to address this issue. Methods: An electronic search using Medline, Cancerlit and Embase databases was performed for studies reporting liver resection for colorectal metasta ses from 1964 to 1999. Data were extracted from papers reporting outcome fo r patients with positive hepatic nodes and analysed according to predetermi ned criteria. Results: Fifteen studies were identified that gave survival data on 145 nod e-positive patients. Five patients were reported to have survived 5 years a fter liver resection; one was disease free, two had recurrent disease and t he disease status was not described in the remaining two. Five studies cont aining 83 patients specified a formal lymph node dissection as part of the surgical procedure and four of the five node-positive 5-year survivors were from these studies. Conclusion: There are few 5-year survivors after liver resection, with or w ithout lymph node dissection, for colorectal hepatic metastases involving t he hepatic lymph nodes.