3622 Background: the role of regional lymphadenectomy for liver metastases and primary liver tumors, but not extra-hepatic bile duct cancer, is debated. Methods: from April ’99 to December ’04, we prospectively evaluated 142 patients treated with liver resections and with the following pre-operative diagnosis: 63 (44.4%) colorectal metastases (M-CR), 48 (33.8%) hepatocellular carcinoma (HCC), 16 (11.3%) non-colorectal metastases (M-NCR) and 15 (10.6%) intra-hepatic cholangiocellular carcinoma (CCC). The regional lymphadenectomy of the hepato-duodenal ligament and of the common hepatic artery was performed in all cases. The incidence and the influence on survival of lymph node metastases were analyzed. Results: 42 “wedge” resection (29.6%), 55 segmentectomies (38.7%) and 45 major hepatectomies (31.7%) were performed. The mean operative time was 292±131 minutes and 96 cases (67.6%) had no blood transfusions during the procedures. Operative mortality (within 30 days) was 3.5%, 48 cases (33.8%) developed post-operative complications and the most common was ascites. The mean hospital stay was 9±5 days. The mean number of nodes (LN) removed were 6.5±5 (range 6–30) and 63 LN (6.5%) had micro-metastases. The incidence of lymph node metastases (LN+) according to the pre-operative diagnosis was: 15.9% M-CR, 4.2% HCC, 37.5% M-NCR and 40% CCC. The mean follow-up was 37.4±22.6 months, 107 patients (75.4%) are alive and 44 (31.7%) developed tumor recurrence, which was more frequent in LN+ (54.2% vs. 27%, p<0.05). The 1-and 3-years patient survival was significantly affected by lymph node metastases: 92% and 85% LN- vs. 79% and 64% LN+, p<0.05. Conclusions: the regional lymphadenectomy for liver tumors is a safe procedure in tertiary referred centers. The presence of lymph node metastases was an important prognostic factor, which should be evaluated to improve the treatment strategies. No significant financial relationships to disclose.
Pulmonary blastoma with hilar lymph node metastases: Survival for 24 years
