title: Combined hepatectomy and hepatic pedicle lymphadenectomy in colorectal liver metastases is justified.
abstract: The aim of this study was to describe the outcome of patients with colorectal liver metastases (CRLM) and radiological or clinical evidence of metastatic hepatic lymph node involvement who underwent combined hepatectomy and hepatic pedicle lymphadenectomy.
  
  
  
  Retrospective analysis of a prospectively maintained audit of 2082 patients undergoing liver resection for CRLM between 1994 and 2014. Age, type of resection, CT/MRI/PET detection, location, disease recurrence and survival were analysed.
  
  
  
  Combined hepatectomy and hepatic pedicle lymphadenopathy was performed on 76 patients who met the inclusion criteria. 46% of enlarged lymph nodes were located in the hepatic ligament, with 38% retroportal, 38% common hepatic and 33% coeliac nodes. 50% of lymph node resections were positive for metastatic tumour. Pre-operative CT, MRI and CT/PET failed to detect histologically proven lymph node disease in 25/38 patients. Patients with negative nodal histology had a significant overall (44 vs 20 months, p = 0.008) and disease free (20 vs 11 months, p < 0.001) survival advantage.
  
  
  
  Combined hepatectomy and lymph node resection for CRLM in the setting of enlarged or suspicious lymphadenopathy is justified as imaging and operative findings are poor guides in determining positive lymph node disease.
authors.affiliation: St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK. Electronic address: russell.hodgson@gmail.com.
authors.forename: Russell
authors.initials: R
authors.lastname: Hodgson
authors.affiliation: St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
authors.forename: Harsheet
authors.initials: H
authors.lastname: Sethi
authors.affiliation: St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Ling
authors.affiliation: St James's University Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Lodge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008485:Medical Audit; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome