title: Metachronous resection of metastatic lymph nodes in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Lymph node metastases are common at autopsy; being found in 28% of autopsy cases of hepatocellular carcinoma have lymph nodes metastases. However, effective treatment for metastatic lymph nodes has not yet been established.
  
  
  METHODS
  We resected lymph node metastases in 8 out of 10 hepatocellular carcinoma patients. We assessed the clinical course and the prognosis of these patients to determine the effectiveness of resecting metastatic lymph nodes and the factors related to survival.
  
  
  RESULTS
  Eight out of 10 patients underwent lymph node resection nine times, while removal of metastatic lymph nodes proved impossible in two patients. The 1-year survival rate was 89% in resected cases. Two patients survived for more than 2 years without recurrence or with controlled recurrence of their cancer. The two unresectable patients had a poor prognosis, with the largest survival time being 11 months.
  
  
  CONCLUSIONS
  Surgical resection is an option for selected patients with lymph node metastases of hepatocellular carcinoma and the complete removal of metastatic lymph nodes may achieve a survival benefit in selected patients. Metachronous lymph node metastases should be resected in patients with a controlled primary liver tumor, because no other treatment option for lymph nodes metastases has yet been established.
authors.affiliation: Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan. masajih-ind@umin.ac.jp
authors.forename: Masaji
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Masamichi
authors.initials: M
authors.lastname: Matsuda
authors.forename: Goro
authors.initials: G
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome