title: Diagnosis and impact of hilar lymph node micrometastases on the outcome of resected colorectal liver metastasis.
abstract: OBJECTIVE
  Liver resection is the only curative therapy for metastatic colorectal cancer. However, recurrence occurs in the majority of the cases. Hilar lymph node metastases occur with a high frequency but the methodology for its detection and the impact on the outcome of patients undergoing hepatectomy is still unknown.
  
  
  METHODS
  Twenty-six patients submitted to partial liver resection and systematic lymphadenectomy were studied prospectively. Lymph nodes considered negative by hematoxylin and eosin (H&E) staining were analyzed by serial sectioning and immunohistochemistry (IHC) with anti-human pancytokeratin antibody AE1/AE3. Recurrence-free and overall survivals were compared among LN groups.
  
  
  RESULTS
  The mean number of dissected lymph nodes were 6.3 per patient. H&E showed microscopic involvement of LN in 2 patients and 3 patients had metastases identified only by IHC. The median follow-up was 39.3 months. Sixteen patients (61.5%) recurred after liver resection and although no statistical difference in survival was demonstrated there was a trend towards shorter recurrence-free survival among microscopic positive LN.
  
  
  CONCLUSIONS
  Microscopic LN metastases may have impact in the outcome of patients submitted to curative hepatectomy. A better definition of micrometastases to LN is warranted, as though the potential benefit of hilar lymphadenectomy and chemotherapy selection by hilar lymph node status.
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Renato M
authors.initials: RM
authors.lastname: Lupinacci
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: Fabricio C
authors.initials: FC
authors.lastname: Coelho
authors.forename: Eduardo F
authors.initials: EF
authors.lastname: Viana
authors.forename: Luiz A C
authors.initials: LA
authors.lastname: D'Albuquerque
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D009364:Neoplasm Recurrence, Local