Combined hepatectomy and hepatic pedicle lymph node resection in colorectal liver metastases is justified

Abstract

Aims: In this study we assess the outcome of patients undergoing combined hepatectomy and hepatic pedicle lymphadenectomy for colorectal liver metastases (CRLM). Methods: Retrospective analysis of a prospectively maintained audit of 2082 patients undergoing liver resection for CRLM between 1994 and 2014. Combined hepatectomy and hepatic pedicle lymphadenectomy was performed on 76 consecutive patients. Age, type of resection, CT/MRI/PET detection, location, R0/1/2 resection, disease recurrence and survival were analysed. Results: 46% of enlarged lymph nodes were located in the hepatic ligament, with 38% retroportal, 38% common hepatic and 33% coeliac nodes. Pre-operative CT, MRI and CT/PET failed to detect histologically proven lymph node disease in more than half of patients. Conversely only 50% of lymph node resections were positive for metastatic tumour. 1-year, 3-year and 5-year overall survival for the cohort was 85%, 43% and 27% respectively; disease free survival was 55%, 27% and 21% respectively. Patients with negative nodal histology had a significant overall and disease free survival advantage (median overall survival 43.9 vs 19.7 months (p<0.01), median disease free survival 19.6 vs 10.8 months (p<0.01)). Conclusions: Combined hepatectomy and lymph node resection in CRLM is justified as imaging and operative findings are poor guides in determining positive lymph node disease.