Surgical treatment of lymph node metastases from hepatocellular carcinoma

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 18; no. 4; pp. 559 - 566
• Main Authors: Kobayashi, Shin, Takahashi, Shinichiro, Kato, Yuichiro, Gotohda, Naoto, Nakagohri, Toshio, Konishi, Masaru, Kinoshita, Taira
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.07.2011; Wiley Subscription Services, Inc
• Subjects: Abdomen; Abdominal Surgery; Aged; Biopsy; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - surgery; Confidence intervals; Disease-Free Survival; Female; Follow-Up Studies; Gastroenterology; hepatocellular carcinoma; Hepatology; Humans; Japan - epidemiology; Liver cancer; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Lymph Node Excision - methods; lymph node metastases; Lymphatic Metastasis - diagnosis; Lymphatic system; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Metastasis; Original Article; Ovarian cancer; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate - trends; Tomography, X-Ray Computed; Treatment Outcome; Japan; Lymph node metastases; Hepatocellular carcinoma; Surgery
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-011-0372-y

Background No consensus has been reached on the feasibility and efficacy of surgery for lymph node metastases (LNM) from hepatocellular carcinoma (HCC). Methods Of 2189 patients with HCC treated at our hospital between July 1992 and March 2008, we retrospectively reviewed the medical dossiers of the 18 patients (0.8%) who underwent lymph node resection and were pathologically diagnosed to have LNM from HCC. The surgical procedure for LNM was selective lymphadenectomy of those lymph nodes suspected to harbor metastasis. The feasibility and efficacy of selective lymphadenectomy was examined, and clinicopathological factors were analyzed with the aim of determining which patients would most benefit from surgery. Results Eighteen patients underwent surgery without mortality or liver failure. Morbidities were found in four patients (22.2%). The median survival time (MST) after surgery was 29 months [95% confidence interval (CI) 21–38 months). The 1-, 3-, and 5-year overall survival rates were 85, 42, 21%. The median progression-free survival (PFS) after surgery was 6 months (95% CI 1–11 months), and the median extrahepatic PFS was 16 months (95% CI 13–18 months). Single LNM was the only favorable prognostic factor after surgery (Hazard ratio 0.082, 95% CI 0.008–0.83). Conclusion Selective lymphadenectomy of LNM from HCC was a feasible and efficacious procedure. Survival rates can be expected to improve after selective lymphadenectomy of single LNM.