Hodgson Russell, Sethi Harsheet, Ling Andrew H, Lodge Peter
St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
HPB (Oxford). 2017 Jun;19(6):525-529. doi: 10.1016/j.hpb.2017.01.025. Epub 2017 Feb 16.
The aim of this study was to describe the outcome of patients with colorectal liver metastases (CRLM) and radiological or clinical evidence of metastatic hepatic lymph node involvement who underwent combined hepatectomy and hepatic pedicle lymphadenectomy.
Retrospective analysis of a prospectively maintained audit of 2082 patients undergoing liver resection for CRLM between 1994 and 2014. Age, type of resection, CT/MRI/PET detection, location, disease recurrence and survival were analysed.
Combined hepatectomy and hepatic pedicle lymphadenopathy was performed on 76 patients who met the inclusion criteria. 46% of enlarged lymph nodes were located in the hepatic ligament, with 38% retroportal, 38% common hepatic and 33% coeliac nodes. 50% of lymph node resections were positive for metastatic tumour. Pre-operative CT, MRI and CT/PET failed to detect histologically proven lymph node disease in 25/38 patients. Patients with negative nodal histology had a significant overall (44 vs 20 months, p = 0.008) and disease free (20 vs 11 months, p < 0.001) survival advantage.
Combined hepatectomy and lymph node resection for CRLM in the setting of enlarged or suspicious lymphadenopathy is justified as imaging and operative findings are poor guides in determining positive lymph node disease.
本研究旨在描述接受肝切除联合肝蒂淋巴结清扫术的结直肠癌肝转移（CRLM）患者的结局，这些患者具有转移性肝淋巴结受累的影像学或临床证据。
对1994年至2014年间2082例行肝切除治疗CRLM患者的前瞻性维护审计进行回顾性分析。分析了年龄、切除类型、CT/MRI/PET检测、位置、疾病复发和生存率。
76例符合纳入标准的患者接受了肝切除联合肝蒂淋巴结清扫术。46%的肿大淋巴结位于肝韧带，38%位于门静脉后，38%位于肝总动脉旁，33%位于腹腔干淋巴结。50%的淋巴结切除术有转移性肿瘤阳性。术前CT、MRI和CT/PET未能在25/38例患者中检测到经组织学证实的淋巴结疾病。淋巴结组织学阴性的患者在总生存期（44个月对20个月，p = 0.008）和无病生存期（20个月对11个月，p < 0.001）方面具有显著优势。
对于肿大或可疑淋巴结病的CRLM患者，肝切除联合淋巴结清扫是合理的，因为影像学和手术结果在确定阳性淋巴结疾病方面指导作用不佳。
