Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Vic, Australia.
HPB (Oxford). 2014 Feb;16(2):124-30. doi: 10.1111/hpb.12118. Epub 2013 Jul 19.
Hepatic resection remains the treatment of choice for patients with colorectal liver metastases (CLM). Indications for hepatic resection have been extended to include extrahepatic lymph node groups, resulting in increased survival benefits. The identification of specific lymph pathways and involved nodes is necessary to support the development of guidelines for a more focused approach to the management of this disease. The feasibility of sentinel node mapping should be investigated to define specific lymphatic groups involved in CLM.
Scientific papers published from 1950 to 2012 were sought and extracted from the MEDLINE, PubMed and University of Melbourne databases.
Several studies have reported microscopic lymph node involvement in 10-15% of patients undergoing hepatic resection for CLM in which no macroscopic involvement was evident. In retrospect, over 80% of lymphadenectomies are proven unnecessary. Traditional imaging modalities have limited predictive value in detecting lymph node involvement. Sentinel node mapping has proved an extremely accurate tool in detecting lymph node involvement and can identify patients in whom lymphadenectomy may be beneficial.
Current imaging techniques are inadequate to detect microscopic lymph node involvement in patients with resectable CLM. The use of sentinel node mapping is proposed to identify nodal groups involved and provide management strategies.
肝切除术仍然是结直肠癌肝转移（CLM）患者的首选治疗方法。肝切除术的适应证已扩展至包括肝外淋巴结组，从而提高了生存率。为了支持制定更集中治疗这种疾病的指南，有必要确定特定的淋巴途径和受累淋巴结。应该研究前哨淋巴结绘图的可行性，以确定涉及 CLM 的特定淋巴群。
从 MEDLINE、PubMed 和墨尔本大学数据库中搜索并提取了 1950 年至 2012 年发表的科学论文。
几项研究报告称，在没有明显宏观受累的情况下，接受 CLM 肝切除术的患者中有 10-15%存在微观淋巴结受累。回顾性研究表明，超过 80%的淋巴结切除术是不必要的。传统的影像学检查方法在检测淋巴结受累方面的预测价值有限。前哨淋巴结绘图已被证明是一种非常准确的检测淋巴结受累的工具，并可识别出可能受益于淋巴结切除术的患者。
目前的成像技术不足以检测可切除的 CLM 患者的微观淋巴结受累。建议使用前哨淋巴结绘图来确定受累的淋巴结群并提供管理策略。
