Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases

Background The indication for surgical resection of colorectal liver metastases should be guided by technical feasibility and expected prognostic benefit. The aim of the present study was to analyse the frequency and prognostic significance of lymph node involvement of the hepatoduodenal ligament in the resection of colorectal liver metastases. Methods A series of 126 prospectively documented patients who underwent hepatectomy for metastases of colorectal carcinoma was analysed. The prognostic factors of patients with complete resection (R-0) of the metastases were studied by multivariate analysis. Results R-0 resection was achieved in 94 per cent. The 30-day mortality rate was 2 per cent. In all patients, lymph nodes were excised from the hepatoduodenal ligament, and histological evaluation demonstrated tumour infiltration in 28 per cent of the patients. Multivariate analysis revealed nodal involvement of the hepatoduodenal ligament (P<0.0001) and synchronous or metachronous appearance of liver metastases (P<0.005) as independent prognostic factors. The 3- and 5-year survival rates were 3 and 0 per cent for lymph node-positive patients compared with 48 and 22 per cent respectively for the node-negative group. Conclusion Infiltration of lymph nodes in the hepatoduodenal ligament is the most important prognostic factor following R-0 resection of colorectal liver metastases.