Hepatic Nodes Research Articles

Regional lymph node involvement in patients undergoing liver resection for colorectal cancer metastases

BackgroundWhile the indications for surgery among patients with colorectal cancer liver metastases (CRCLM) are expanding, the role of surgery in patients with hepatic lymph node involvement remains controversial. We report management and outcomes in a population-based cohort of patients undergoing hepatectomy with concomitant hepatic lymphadenectomy for CRCLM. MethodsAll cases of hepatectomy for CRCLM in the Canadian Province of Ontario from 2002 to 2009 were identified using the population-based Ontario Cancer Registry and linked electronic records of treatment. Pathology reports were used to identify concomitant lymphadenectomy with liver resection as well as extent of disease and surgical procedure. ResultsAmong 1310 patients who underwent resection for CRCLM, 103 (8%) underwent simultaneous regional lymphadenectomy. Seventy-one percent of cases with lymphadenectomy (70/103) had a major liver resection (≥3 segments). Of the 103 lymphadenectomy cases, 80 (78%) were hepatic pedicle, 16 (16%) were celiac and 7 (7%) were para-aortic. The mean number of nodes removed was 2.2 (range 1–15). Ninety-day mortality was 6%. Twenty-nine percent (30/103) of cases had positive nodes. Unadjusted overall survival at 5 years for positive vs negative nodes was 21% vs 42% (p = 0.003); cancer-specific survival was 10% vs 43% (p < 0.001). In adjusted analyses, hepatic node involvement was associated with inferior OS (HR 2.19, p = 0.010) and CSS (HR 3.07, p = 0.002). ConclusionsPatients with resected CRC liver metastases with regional lymph node involvement have inferior survival compared to patients with negative nodes. Despite this poor prognostic factor, a small proportion of cases with involved nodes will achieve long-term survival.

A case of neuroendocrine carcinoma in the hepatic hilar lymph nodes concomitant with an adenocarcinoma of the gallbladder

BackgroundNeuroendocrine tumors (NETs) are rare especially in the gallbladder. They have not been elucidated in the pathogenesis, clinicopathological characteristics, and treatment options.Case presentationWe present a 76-year-old woman with a gallbladder tumor and hepatic hilar lymph node swelling. The lymph node biopsy demonstrated neuroendocrine carcinoma (NEC). We performed cholecystectomy, hepatic hilar lymphadenectomy, extrahepatic biliary duct resection, and hepaticojejunostomy prior to chemotherapy. Pathological examination revealed the gallbladder mass was an adenocarcinoma invading to the muscular layer without any NEC components, whereas the hepatic hilar lymph nodes were filled with high-grade NEC cells with negligible area of adenocarcinoma. The patient received general chemotherapy consisting of carboplatin and etoposide, but a recurrence in the para-aortic lymph nodes occurred 4 months after surgery.ConclusionsWe report a rare case of NEC of the hepatic hilar lymph nodes that were concomitant with an adenocarcinoma of the gallbladder. High-grade NEC generally has an aggressive behavior and an optimal treatment strategy should be chosen for each patient.

Distribution of Foxp3+ T cells in the liver and hepatic lymph nodes of goats and sheep experimentally infected with Fasciola hepatica

Foxp3 regulatory T cells (Tregs) are now considered to play a key role in modulation of immune responses during parasitic helminth infections. Immunomodulation is a key factor in Fasciola hepatica infection; however, the distribution and role of Foxp3+ Tregs cells have not been investigated in F. hepatica infected ruminants. The aim of this study was to evaluate the presence of Foxp3+ Tregs in the liver and hepatic lymph nodes from experimentally infected sheep and goats during acute and chronic stages of infection. Three groups of goats (n=6) and three groups of sheep (n=6) were used in this study. Goats in groups 1–2 and sheep in groups 4–5 were orally infected with metacercarie of ovine origin. Groups 1 and 4 were killed during the acute stage of the infection, at nine days post infection (dpi); groups 2 and 5 were killed during the chronic stage, at 15 and19 weeks post infection respectively (wpi). Groups 3 (goats) and 6 (sheep) were left as uninfected controls. Fluke burdens and liver damage were assessed and the avidin–biotin–complex method was used for the immunohistochemical study. At nine dpi in acute hepatic lesions, the number of both Foxp3+ and CD3+ T lymphocytes increased significantly in goats and sheep. In the chronic stages of infection (15–19wpi), the number of Foxp3+ and CD3+ T lymphocytes were also significantly increased with respect to control livers, particularly in portal spaces with severely enlarged bile ducts (response to adult flukes) while the increase was lower in granulomas, chronic tracts and smaller portal spaces (response to tissue damage). Foxp3+ Tregs were increased in the cortex of hepatic lymph nodes of sheep (chronic infection) and goats (acute and chronic infection). The estimated proportion of T cells which were Foxp3+ was significantly increased in the large bile ducts and hepatic lymph node cortex of chronically infected goats but not sheep. This first report of the expansion of Foxp3+ Tregs in acute and chronic hepatic lesions in ruminants suggests that these cells may be involved in both parasite survival and modulation of hepatic damage. Future studies should be focused on the investigation of parasite molecules and cytokines involved in this process.

Low dose palliative radiotherapy for refractory aggressive lymphoma

AimTo determine the efficacy of low-dose palliative radiotherapy in patients with refractory aggressive lymphoma. BackgroundThere are few reports on the administration of palliative radiotherapy to patients with aggressive lymphoma. Materials and methodsThe present study included 11 patients with 30 sites of aggressive lymphoma (diffuse large cell lymphoma, n=7; mantle cell lymphoma, n=2; follicular large cell lymphoma, n=1; and peripheral T cell lymphoma, n=1). The patients received local palliative radiotherapy after receiving a median of 4 chemotherapy regimens. The radiotherapy doses administered to the 30 sites were as follows: 8Gy, single fraction (n=27); 6Gy, single fraction (n=1); 4Gy, single fraction (n=1); and 4Gy, 2 fractions (n=1). ResultsThe complete response rate was 45% (5/11); the partial response rate was 36% (4/11). Toxicity occurred at one irradiated site (the mandibular), which showed temporal acute gingivitis; however, medication was not required. Retreatment was required for 3 sites on the head (parotid, face and mandible) due to persistent discomfort. None of the other sites (27/30) required retreatment. A patient with refractory DLBCL underwent radiotherapy (4Gy, single fraction) for hepatic hilar lymph node involvement but did not recover from jaundice and died of DLBCL. ConclusionsEight Gray single fraction radiotherapy was one of meaningful options for the treatment of refractory aggressive lymphoma in terms of its efficacy and the incidence of adverse events. The use of 8Gy single fraction radiotherapy is therefore recommended for achieving local control in patients with refractory aggressive lymphoma.

Chronic liver disease in cattle associated with ingestion of Brachiaria spp.

ABSTRACT: One hundred and ninety livers condemned due to chronic disease (fibrosis) were evaluated in a bovine slaughterhouse over 12 months. Hepatic lymph nodes were also examined while still attached to livers. The major macroscopic lesion observed in the livers was moderate to severe atrophy of the left lobe associated with compensatory hypertrophy of the right lobe. Histologically, the main changes corresponded to sites of macroscopic lesions, and fibrosis was observed in all livers, along with bile duct hyperplasia and neovascularization. Masson's trichrome stain highlighted the fibrous connective tissue. Most of the livers analyzed had macrophages with foamy cytoplasm and a peripheral nucleus that infiltrated fibrotic areas. Immunohistochemistry (IHC) for macrophages with monoclonal antibody clone MAC 387 revealed that the cytoplasm of the foamy macrophages of the liver and of the hepatic lymph nodes were positively immunostained. These cells are frequently associated to the consumption of grasses of the genus Brachiaria. Although the liver gross lesions described in this study have not been previously reported in animals consuming Brachiaria , the associated changes observed histologically, such as fibrosis and infiltration of foamy macrophages, showed a new form of chronic liver disease probably associated with the consumption of this forage. The IHC technique was important to prove that the foam cells observed are macrophages.

MicroRNA Expression in a Readily Accessible Common Hepatic Artery Lymph Node Predicts Time to Pancreatic Cancer Recurrence Postresection

Lymph node involvement in pancreatic adenocarcinoma (PAC) predicts postresection survival, but early lymph node metastasis detection is not easily accomplished. We assessed a panel of microRNAs (miRNAs) in a common hepatic artery lymph node (station 8) that is readily accessible during pancreatoduodenectomy (PD) to determine if increased miRNA levels correlate with postresection recurrence. Station 8 lymph nodes overlying the common hepatic artery collected during PD were assayed for miRNA-10b, miRNA-30c, miRNA-21, and miRNA-155 and cytokeratin-19 (CK19), an epithelial cell marker, using quantitative PCR. Expression was correlated with disease recurrence, recurrence-free survival (RFS), and overall survival (OS). Station 8 lymph nodes from 37 patients (30 periampullary carcinomas (PCs), 2 chronic pancreatitis, 5 other cancers) exhibited increased miRNA-10b levels in 14/30 PCs, and in 10 of these 14 patients, cancer recurred during the study period (2012–2015). High miRNA-10b was also associated with shorter RFS (42.5 vs. 92.4 weeks, p < 0.05) but not OS, whereas miRNA-30c, miRNA-21, and miRNA-155 levels and CK19 mRNA levels in station 8 nodes were variable and did not correlate with RFS or OS. We conclude that elevated miRNA-10b levels in station 8 lymph nodes could be utilized to assess risk for early disease progression in patients with periampullary tumors.

Chylous Ascites in Advanced Gallbladder Cancer.

Chylous ascites is a very rare occurrence in a patient with gallbladder cancer (GBC), and only six cases have been reported. We report here one such case in a 55-year-old lady who presented to us with upper abdominal pain for 6months. A polypoidal gallbladder mass with minimal liver invasion but with multiple subcentimeter pericholedochal, common hepatic, mesenteric, and para-aortic lymph nodes was found on contrast-enhanced computed tomography scan. At laparotomy, the abdomen had milky fluid with engorged beaded lymphatics all over the small intestine. The abdomen was closed over a drain after a lymph node biopsy and collection of the ascetic fluid for analysis. Histopathology confirmed metastatic adenocarcinoma in the lymph node. The triglyceride levels in the ascetic fluid were elevated to 817.00mg/dl. The patient was put on medium-chain triglyceride diet and a diuretic and recovered well. She was discharged when drain output was nil. Chylous ascites could be a result of abdominal malignancy, post surgery, cirrhosis, and disseminated infections like tuberculosis and filariasis. Treatment is primarily conservative and includes paracentesis/drainage of the peritoneal cavity supplemented by fasting, total parenteral nutrition, and/or diet modification with medium-chain triglyceride diet.

Abstract 1725: The significance of c-Kit proto-oncogene in iCSC-derived PDAC model

Abstract Our study is focused on the generation of a novel pancreatic iPS-derived cancer stem cell line (iCSC), as a cutting-edge model of study for PDAC, and the significance of the proto-oncogene c-Kit in PDAC, using the new model of iCSC-derived PDAC generated in vivo. Pancreatic ductal adenocarcinoma (PDAC) is a neoplasia that originates within the pancreatic ducts. The mortality rate is high due to its rapid dissemination, the strong resistance to the radio and chemotherapy, along with the lack of prognostic approaches. Therefore, this highlights the urgent need to find novel therapies along with new pancreatic cancer markers towards the early detection of the primary stages of the PDAC. The iCSC cells were orthotopically transplanted into the pancreas of Balb/c nude mice. After a short-time course of 15 days, PDAC progression was recapitulated not only at the level of the tumour phenotype, but also with the corresponding invasion towards specific hepatic metastatic nodes. iCSC cells were obtained from iPS, following the procedure previously established by our group, where the reprogramming is accomplished exclusively through conditioned medium, without any genetic modification, which may represent a substantial tool to study fairly about the insights on the actual tumour microenvironment. In order to confirm these experiments are reproducible, iPS were cultured with different pancreatic cancer cell line -PK-8, KLM-1 and PK-59-conditioned medium. Histochemistry assay of the tumour developed in vivo demonstrated the effectiveness of the conversion from iPS into iCSC among the cell lines, generating stroma-rich ductal adenocarcinoma structures that resemble the human tumour phenotype. The tyrosine receptor c-Kit is expressed only during the embryonic pancreas differentiation, whereas adult pancreatic normal tissues lack the expression of the receptor. However in PDAC, its overexpression seems to be tightly correlated with the progression of the disease, and c-Kit has been suggested as a CSC marker. The overexpression of c-Kit receptor was observed at protein and mRNA expression level, in the primary cultures of iCSC-derived PDAC tumours. Interestingly, this overexpression is directly related to the tumour phenotype, being the most disrupted ductal structures those, which show the c-Kit over-expression. Additionally, CSC from the primary cultures of iCSC-derived PDAC were isolated by puromycin selection as well as sphere formation, and after 7 days of culture the mRNA expression levels of Pax4 appears to be up-regulated, suggesting that iCSC cells indeed may differentiate into a tissue-specific lineage. Hence, c-Kit might be a prominent candidate as a CSC marker in PDAC, and according to the current results we have generated a suitable PDAC model, which recapitulates the actual disease in a short-time course, and allows the study of the actual tumour microenvironment. Citation Format: Anna Sanchez Calle, Kenta Hoshikawa, Neha Nair, Marta Prieto-Vila, Arun Vaidyanath, Tomonari Kasai, Masaharu Seno. The significance of c-Kit proto-oncogene in iCSC-derived PDAC model. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1725.

Preliminary results of ultrasound-guided laser ablation for unresectable metastases to retroperitoneal and hepatic portal lymph nodes.

BackgroundLaser ablation with a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a minimally invasive approach which is able to achieve a precise tissue necrosis. The study was aimed to assess the feasibility and efficiency of laser ablation in the treatment of retroperitoneal and hepatic portal unresectable metastatic lymph nodes.MethodsEight patients including 11 pathologically proven metastatic lymph nodes, 4 in retroperitoneal, 7 in hepatic portal region, were treated by laser ablation. Primary cancers were cholangiocarcinoma (n = 4) and hepatocellular carcinoma (n = 4). Under sonographic guidance, the laser ablation was performed percutaneously. Follow-up contrast computed tomography or magnetic resonance image was performed.ResultsThe treatments were completed in single process in all the patients. No severe complications occurred. Follow-up contrast computed tomography or magnetic resonance imaging at 1 and 3 months showed partial responses in 11 lymph nodes. The local response rate at the 6 month follow-up was 75.0 %. The overall response rate was 62.5 %. Abdominal pain scores decreased significantly in all patients. Tumor marker levels decreased in six patients. The Child-Pugh grade did not change.ConclusionsThe results suggest that sonographically guided laser ablation is technically feasible for the local treatment of unresectable retroperitoneal and hepatic portal lymph nodes from hepatic cancer. Although further study is needed to evaluate its long time efficacy, abdominal pain relief is prominent.

Pancreatoduodenectomy due to ductal adenocarcinoma of the pancreas – Does the invasion of the hepatic artery lymph node have the prognostic factor on the patient survival?

Pancreatoduodenectomy due to ductal adenocarcinoma of the pancreas – Does the invasion of the hepatic artery lymph node have the prognostic factor on the patient survival?

Spontaneous poisoning by Brachiaria decumbens in goats

Abstract: An outbreak of Brachiaria decumbens poisoning in goats in the state of Mato Grosso do Sul, Brazil, is described. Out of a herd of about 1,000 goats, seven goats died after showing photosensitivity (3 out 7 goats) and icterus (4/7). Other clinical signs included lethargy, dehydration and weight loss (7/7). At necropsy there was either hepatomegaly or liver atrophy; orange, yellow or gray discoloration - were observed in the liver of six goats. Two had accentuation of lobular pattern and punctate, linear or stellar fibrous depressions were randomly distributedover the capsular surface. Macroscopic changesattributedto liver failure consisting of hydropericardium (2/7) and ascites (2/7) were observed. Histologically, there was accumulation of refringent crystals in the bile ducts and infiltration of foamy macrophages in the liver of all goats. Foamy macrophages were also present in the hepatic and mesenteric lymph nodes of two goats. The diagnosis of B. decumbens poisoning was based on epidemiology, clinical signs, necropsy findings and histopathology.

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

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.

Long-term survival of a recurrent gallbladder carcinoma patient with lymph node and peritoneal metastases after multidisciplinary treatments: a case report.

BackgroundGallbladder carcinoma with peritoneal metastasis has a poor prognosis, with a median survival time of 4.8 months. We report the survival of a patient with gallbladder carcinoma with peritoneal metastasis for 7.6 months owing to treatment with tumor resection after chemoradiotherapy.Case presentationA 69-year-old man was referred to our hospital for gallbladder carcinoma with hepatic invasion. Cholecystectomy was performed along with S4a and S5 hepatectomy and extrahepatic bile duct resection with lymph node dissection. The postoperative pathological diagnosis was moderately differentiated adenocarcinoma, T3, N0, M0, stage IIIA by the International Union Against Cancer TNM classification. Despite treatment with gemcitabine, the common hepatic artery and para-aortic lymph nodes showed metastases after 3 months from surgery. Although a combination of cisplatin, gemcitabine, and radiotherapy reduced the size of the lymph node metastasis, the peritoneal metastasis persisted. The peritoneal metastasis responded to chemoradiotherapy using tegafur-uracil and leucovorin, but it recurred. The metastasis was resected after 3 years and 9 months from the first surgery, and chemotherapy was discontinued. Seven years and 6 months after the initial surgery, the patient exhibited no signs of tumor recurrence or metastasis.ConclusionsMultidisciplinary treatment including resection without residual tumors could achieve complete remission of gallbladder carcinoma with lymph node and peritoneal metastases in the selected patient.

Central, But Not Peripheral, Circulating Tumor Cells are Prognostic in Patients Undergoing Resection of Colorectal Cancer Liver Metastases.

Colorectal cancer liver metastases (CRLMs) are potentially curable with resection, but most patients recur and succumb to their disease. Clinical covariates do not account for all outcomes. Circulating tumor cells (CTCs) are prognostic in the primary and metastatic settings of breast, prostate and colorectal cancer (CRC), and evolving evidence supports their role in CRLMs. Our objective was to determine whether CTCs in peripheral (PV) and hepatic venous (HV) compartments are associated with disease-free survival (DFS) and overall survival (OS) post-CRLM resection. CTCs were measured by CellSearch assay from intraoperative HV and PV samples from 63 patients who underwent CRLM resection from June 2007 to August 2012 at a single center. DFS and OS were primary endpoints. HV CTCs > 3 were associated with shorter DFS and OS, but not PV CTCs, although no significant difference was found between CTC measurements in the two compartments. By univariate analysis, CRC stage and site, CRLM recurrence, and hepatic capsule invasion were also associated with OS, but only HV CTCs and CRC site were significant by multivariate Cox. Only HV CTCs were associated with DFS by multivariate analysis. Cases with elevated HV CTCs had hepatic vein invasion and lymph node metastases, and were younger with larger tumors. Elevated HV CTCs are prognostic for DFS and OS following CRLM resection. Clinicopathologic features associated with HV CTCs are identifiable preoperatively and should be considered in CRLM surgical decision making. We found no evidence that PV CTCs are prognostic in this setting.

MicroRNA expression in common hepatic artery lymph nodes as a prognostic marker in pancreatic ductal adenocarcinoma

MicroRNA expression in common hepatic artery lymph nodes as a prognostic marker in pancreatic ductal adenocarcinoma

Pancreatic hemangioendothelioma, an extremely rare vascular anomaly in children: A case report and literature review.

The current study presents the case of a female infant with pancreatic hemangioendothelioma (HE) and discusses this rare disease in terms of the clinical features, treatment principle and prognosis. An 8-month-old female with pancreatic HE was admitted to the Department of General Surgery in The Children's Hospital (Zhejiang University School of Medicine, Hangzhou, Zhejiang, China) on January 3, 2011, due to yellow skin and sclera that had been apparent for 1 week. Magnetic resonance imaging (MRI) showed dilatation in the left and right hepatic, common hepatic and common bile ducts, a pancreatic head mass of ~4.7×5.2 cm with a strong signal, and close linkage of the portal vein and mesenteric vessels to the mass. Laparotomy was performed on January 11, 2011. An intraoperative frozen specimen showed a benign tumor. Finally, Whipple surgery retaining the tumor was chosen. The patient was treated by fasting, gastrointestinal decompression, antibiotics and supportive treatment post-surgery. Jaundice disappeared rapidly following the surgery. The patient started eating at 1 week post-surgery and was discharged 1 week later. From the pathological results, a diagnosis of pancreatic HE was made, with no tumor invasion of the hepatic lymph nodes. During the follow-up visit at 28 months post-surgery, the child showed good growth and development. MRI showed that the mass size was ~2.4×2.0×1.5 cm, which was a significantly decrease from previously. Additionally, a literature search showed that from 1973 to the present date, only 9 studies on children with HE of the pancreas have been reported. Childhood pancreatic HE is a rare form of pancreatic vascular anomaly, mainly occurring in infants. If the tumor oppresses the duodenum and invades the mesenteric vessels, Whipple surgery retaining the tumor could be performed.

Comparison of accuracy of CT and MRI in the preoperative evaluation of malignant perihilar biliary obstruction

Objective To summarize the imaging features of computed tomography (CT )and magnetic resonance imaging (MRI) combined with multi-technology imaging and compare its effects in the preoperative evaluation of malignant perihilar biliary obstruction. Methods The clinical data of 20 patients receiving CT and MRI who were diagnosed with malignant perihilar biliary obstruction by pathological examination at the Wuxi Second People's Hospital between January 2008 and April 2014 were retrospectively analyzed. Patients receiving CT combined with negative-contrast CT cholangiopancreatography (nCTCP) and computed tomography angiography (CTA) were allocated into the CT group, and patients receiving MRI combined with magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance angiography (MRA) were allocated into the MRI group. The images of the 2 groups were analyzed by 2 independent reviewers. The classification of malignant perihilar biliary obstruction, hepatic artery and portal vein invasions and lymph node and organ metastases were evaluated respectively, and then the results of evaluation were compared with the results of surgery and pathological examinations. The comparison between the accuracy of imaging examination in the 2 groups and accuracy of perihilar biliary obstruction classification were analyzed by the chi-square test. The comparison of evaluating accuracy (sensitivity and specificity) among vascular invasion and lymph node and organ metastases were done by the receiver operating characteristic (ROC) curve analysis, and the comparison of its accuracy were done by thez-score test. Results The imagings of bile duct involvement of the 2 groups showed that there were irregular thickening bile duct wall combined with retrograde intrahepatic bile duct dilatation. The symptoms of vascular invasion included the stricture and occlusion of blood vessels or more than half of vascular contact surface with tumor. The symptoms of lymph node metastasis included the enlarging short-axis or round-like circular enhanced lesions. The symptoms of organ involvement included the unclear boundary of lesions or low-density necrotic foci within organ. All the 20 patients underwent the surgical treatment, including 13 patients with hilar cholangiocarcinoma and 7 patients with gallbladder carcinoma. Hepatic artery invasions were detected in 5 patients, portal vein invasions in 10 patients, lymph node metastases in 10 patients and organ metastases in 4 patients. The cases of classification of perihilar biliary obstruction, hepatic artery invasion, portal vein invasion, lymph node metastasis and organ metastasis which were evaluated respectively by reviewer 1 and 2 were 18/ 18, 19/ 18, 18/ 18, 17/ 16 and 18/ 19 in the CT group and 17/ 16, 14/ 13, 17/ 16, 15/ 14 and 19/ 18 in the MRI group. The imaging of the 2 groups were compared with the evaluating accuracies of classification of malignant hilar biliary obstruction, hepatic artery and portal vein invasions, lymph node and organ metastases in the 2 groups, showing no significant differences (χ2=12.593, 8.889, z=1.823, 1.956, 0.462, 0.817, 0.977, 0.751, 0.233, 1.403, P >0.05) . Conclusion CT and MRI for malignant hilar biliary obstruction had the same imaging features, meanwhile, they can provide an equivalent performance in the classification of malignant hilar biliary obstruction, hepatic artery and portal vein invasions and lymph node and organ metastases. Key words: Perihilar biliary obstruction; Malignance; Tomography, X-ray computed; Magnetic resonance imaging

Survival of proper hepatic artery lymph node metastasis in patients with gastric cancer: implications for D2 lymphadenectomy.

Background and AimsThere is a discrepancy between the American Joint Committee on Cancer (AJCC) guidelines (7th edition) and the Japanese treatment guidelines (3rd edition) with regard to the extent of D2 lymphadenectomy for gastric cancer. In the AJCC, hepatic artery station (No.12a) lymph node (LN) metastasis is classified as distant metastasis, whereas in the Japanese guidelines, this classified is regional metastasis. This study aimed to evaluate whether it is appropriate to reclassify No.12a LN metastasis as distant metastasis in consideration of survival outcome.MethodsIn this retrospective analysis, data from patients with gastric cancer who underwent regular D2 or greater lymphadenectomy between 1996 and 2006 were evaluated to determine any association between the clinicopathological features of hepatic artery LNs and survival prognosis.ResultsAmong the 247 patients with gastric cancer who underwent No.12 LN harvest, 45 (18.2%) were positive for No.12a LN metastasis. No.12a LN metastasis was significantly associated with poor clinicopathological features, advanced tumor stage, and poor overall survival. The 5-year survival rate of patients with No.12a LN metastasis was significantly better than that of patients with distant metastasis (P < 0.05), but was similar to that of patients with LN involvement in the D2 lymphadenectomy region (P > 0.05). No.12a LN metastasis was shown to significantly influence survival outcome in univariate analysis, but was not identified as a significant independent predictor in multivariate analysis. In logistic multivariate regression analysis, T stage, N stage, and station No.3, 5, and 6 LN metastasis were independent predictors of No.12a LN involvement.ConclusionsIt is inappropriate to reclassify No.12a LN metastasis as distant metastasis. We propose that this be considered as regional metastasis and be included in the extent of D2 lymphadenectomy to improve survival outcomes in patients with gastric cancer.

Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution

Although use of lymphadenectomy for treatment of extrahepatic cholangiocarcinoma is established, routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) remains controversial. We examined the factors predicting survival in patients after ICC resection and compared outcomes of patients with and without systematic hepatic pedicle lymph node dissection (LND). Data were retrospectively collected for 215 patients with ICC who underwent liver resection during the years 1995-2012. Patients were divided into those (n = 102; 47.4%) who received LND (LN [D]) and those (n = 113; 52.6%) who did not (LN [D0]). Demographic data were similar between the 2 groups except for presence of preoperative symptom (P = .019) and liver cirrhosis (P < .001), carbohydrate antigen 19-9 (P = .003), tumor location according to the hepatic lobe (P < .001), type of hepatectomy (P < .001), adjuvant treatment (P < .001), and postoperative complications (P = .028). Tumor recurrence at a distant site was observed in 102 patients (68.5%). LN metastasis was independently associated with risk of distant recurrence (P = .002). The LN (D) and LN (D0) groups did not differ in overall survival (P = .101) or disease-free survival (P = .111). Poorly differentiated histologic grade (P = .016) and LN metastasis (P < .001) was identified as an independent predictor of overall survival. Routine LND for ICC did not show survival benefits; however, LN sampling might be useful for nodal staging, an essential factor in predicting outcome and deciding whether to apply adjuvant treatment.

Hepatic Resection for Extrahepatic Metastatic Disease: When Is It Reasonable?

The presence of limited and resectable extrahepatic metastases (EHM) in addition to colorectal liver metastases (LM) is no longer a contraindication to surgery. Long-term survival (between 25 and 30 % at 5 years) is possible for highly selected patients. The site of occurrence is a key prognostic factor. Results are best for lung EHM and limited peritoneal metastases (PM), lower when EHM invade the proximal hepatic lymph nodes, and worse for other EHM. Treatment decision making is difficult when faced with an infinite number of possible combinations between the different sites of metastases, their number, and the overall tumor load. General performance status, technical contingency, and chemosensitivity are also important factors to be reckoned with. In the future, a considerable amount of data concerning these patients and new statistical tools will be required to create clear decision trees.