Abstract
In patients with colorectal liver metastases (CLM), hepatic pedicle lymph node (HPLN) involvement has been one of the most powerful prognostic factors associated with poor survival after liver resection. Whereas surgical resection of LN positive primary colorectal cancer can lead to a large number of cured patients, surgical resection alone has not improved prognosis of patients with CLM who have HPLN involvement. Therefore, those patients should be treated with a combination of surgical resection and perioperative systemic chemotherapy. The frequency of HPLN involvement in patients with CLM is as high as to 20%. To this day, there are no reliable imaging modalities to accurately detect HPLN involvement before surgery. Current studies show that routine en-bloc surgical resection of involved HPLN in patients with CLM does not seem to confer a survival benefit, and adequate studies evaluating the best treatment algorithm for these patients are lacking. With improved systemic treatment options, surgical removal of involved HPLN nodes may be worth applying in patients with PET-positive nodes and patients with relapsed HPLN after curative resection who demonstrate a long-term response to chemotherapy, but at this time this cannot be viewed as standard of care.
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Narita, M., Ikai, I., Fuchshuber, P., Bachellier, P., Jaeck, D. (2017). Nodal Involvement. In: de Santibañes, E., Ardiles, V., Alvarez, F., Busnelli, V., de Santibañes, M. (eds) Extreme Hepatic Surgery and Other Strategies. Springer, Cham. https://doi.org/10.1007/978-3-319-13896-1_22
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