title: Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis.
abstract: BACKGROUND
  Macroscopic hepatic lymph node involvement is usually a contraindication to hepatic resection. Only a few studies have investigated the impact of hepatic lymph node involvement on survival. The aim of this retrospective study was to assess microscopic hepatic lymph node involvement in resectable colorectal liver metastasis and outcomes in patients with such involvement.
  
  
  METHODS
  From January 1985 to December 2000, 156 patients underwent curative liver resection in association with systematic hepatic lymph node dissection for colorectal liver metastasis. A first analysis was performed to assess the association between hepatic lymph node metastasis and patients' characteristics. A second analysis assessed survival after resection of liver colorectal metastasis by using the Kaplan-Meier method.
  
  
  RESULTS
  Twenty-three of the 156 patients (15%) had microscopically involved hepatic lymph nodes. No predictive factor of lymph node metastasis was identified. Multivariate analysis showed that lymph node metastasis, preoperative carcinoembryonic antigen level, number of metastases, and morbidity were factors influencing survival. The 3- and 5-year survival rates of patients with lymph node metastasis were 27% and 5%, respectively, compared with 56% and 43% without lymph node metastasis (p = 0.0001).
  
  
  CONCLUSIONS
  During resection of liver colorectal metastasis, microscopic lymph node involvement occurred in 15% of the patients and was associated with a poor 5-year survival. Hepatic lymph node dissection should be performed systematically to select high-risk patients.
authors.affiliation: Department of Digestive Surgery, Saint-André Hospital, Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Laurent
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.forename: Eric
authors.initials: E
authors.lastname: Rullier
authors.forename: Denis
authors.initials: D
authors.lastname: Smith
authors.forename: Anne
authors.initials: A
authors.lastname: Rullier
authors.forename: Jean
authors.initials: J
authors.lastname: Saric
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors