The Role of Lymphadenectomy for Liver Tumors

Lymph node status is a definite prognostic factor in oncologic surgery and significantly affects long-term survival, as reported by the tumor staging system of the International Union Against Cancer (IUCC), which is the most widespread classification of malignant tumors worldwide.1 The impact on survival of lymph node metastases has already been reported for lung cancer,2 esophageal cancer,3 and renal cancer.4 The prognostic value and the extent of lymph node dissection are strongly defined for breast carcinoma5 and other gastrointestinal neoplasms.6–8 Some authors have claimed that a minimum number of lymph nodes should be dissected in gastric and colorectal carcinoma to obtain a reliable staging of the tumor.9,10 Regional lymphadenectomy is already the standard procedure that completes hepatic resection in the case of carcinoma arising from the extrahepatic bile duct.11,12 However, the indication, extent, and role of lymph node excision are still a matter of discussion, and no clear guidelines exist in patients with other types of primary or secondary hepatic tumors. An increased operative risk of liver resection has been reported when lymph node dissection is performed in patients with liver tumors.13,14 Therefore, concerns still remain with regard to its routine application. It is of great interest to clarify which patients with hepatic cancers should benefit from lymph node excision, in which cases this procedure should be mandatory and whether the operative risk is really increased by it. We have prospectively evaluated the feasibility and safety of a routine regional lymphadenectomy and the incidence, site, and impact on survival of lymph node metastases in patients with primary and secondary liver tumors amenable to curative liver resection. Our results therefore refer to the most recent therapeutic strategies in the field of liver tumors.