Department of Surgery and Organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Updates Surg. 2010 Aug;62(1):27-34. doi: 10.1007/s13304-010-0008-9.
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.
常规区域淋巴结清扫术用于结直肠肝转移和原发性肝癌仍存在争议。2001-2005 年，我们进行了一项前瞻性研究，比较了肝十二指肠韧带和肝总动脉周围区域淋巴结清扫术（R+LN 组）与未行清扫术（R-LN 组）的患者的临床特征和手术数据。两组患者的术前临床特征和手术数据具有可比性。其中男性 108 例（67%），中位年龄 66 岁，124 例为单发病变（77%），中位直径 4cm。病变类型为：结直肠肝转移 77 例（48%），肝细胞癌 75 例（46%），胆管细胞癌 10 例（6%）。在 R+LN 组中，平均切除淋巴结数为 6.7±4.8（范围 4-26），7 例（8.6%）出现淋巴结转移。中位随访时间为 3.5 年。R+LN 组结直肠肝转移患者的住院死亡率（R+LN 0% vs. R-LN 2.6%）和发病率（R+LN 17.9% vs. R-LN 21.1%）相似，但 R+LN 组患者的 5 年无病生存率更高（31% vs. 16%，p<0.05）。R+LN 组肝细胞癌患者的住院死亡率较高（13.5% vs. 0%，p<0.05），但无病生存率无改善（5 年无病生存率分别为 34%和 33%，p=无统计学意义）。常规区域淋巴结清扫术应应用于结直肠肝转移患者，而对于肝细胞癌患者则应避免。
