Is Partial Hepatectomy Indicated in the Presence of Perihepatic Lymph Node Metastases for Patients with Metastatic Colorectal Cancer?
Abstracts
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Introduction: Perihepatic lymph node metastases (PLNM) are considered a marker of systemic disease and, thus, are perceived as contraindication to partial hepatectomy for metastatic colorectal cancer. Despite isolated reports of 5-year survival after resection, data are sparse. To further explore the significance of PLNM on survival, we reviewed our experience. Methods: All consecutive patients undergoing partial hepatectomy for metastatic colorectal cancer between 1970 and 1995 were studied; only patients with histologic involvement of portal nodes were included. No formal portal lymphadenectomy was performed. The indications for resection were the presence of symptoms related to large metastases and absence of other extrahepatic disease. Follow-up was updated by outpatient visits and mail correspondence. Overall survival and progression-free survival was calculated by the Kaplan-Meier method and the log-rank test was used for comparison. Follow-up was complete to disease recurrence, death or current survival. Results: Twenty-eight patients (16M:12F) (mean age: 60 years) underwent hepatic resection of colorectal metastases and the PLNM. Hepatic metastases were unilateral in 20 (71%). Primary colorectal cancers were TNM Stage II in 6, III in 18, and IV in 4 patients. Median disease-free interval between resection of primary and metastatic disease was 21 months (range 0-108). Perihepatic nodal involvement was intraoperatively overt in 78%. Overall median survival was 25 months and 5-yr was 14%. There were 3 actual 5-yr survivors but only one was alive disease-free. Progression-free median survival was 9 months and 5-yr was 8%. Interestingly, patients with major resections (?1 lobe; n=12) had an increased overall median (35 vs. 17 months, p=0.01) and progression-free survival (15 vs 4 months, p=0.02) compared to patients with minor hepatic resections. Progression-free interval between primary and metastases, and serum level of CEA did not correlate with overall or progression-free survival. Recurrences occurred in the liver after hepatic resection (n=20), lungs (n=2), retroperitoneum (n=1), and unknown (n=1). Conclusions: Our data confirm that PLNM carry an adverse impact on survival of patients with metastatic colorectal cancer. Consequently, hepatic resection in this setting should be performed only to palliate symptoms medically refractory or as a component of investigative multimodality (regional and systemic) therapy. |
