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Annals of Surgical Oncology

, Volume 19, Issue 1, pp 163–168 | Cite as

Neither Preoperative Computed Tomography nor Intra-Operative Examination can Predict Metastatic Lymph Node in the Hepatic Pedicle in Patients with Colorectal Liver Metastasis

  • Cédric Rau
  • Benjamin Blanc
  • Maxime Ronot
  • Safi Dokmak
  • Béatrice Aussilhou
  • Sandrine Faivre
  • Valérie Vilgrain
  • Valérie Paradis
  • Jacques Belghiti
Hepatobiliary Tumors

Abstract

Background

In patients operated on for colorectal liver metastasis (CRLM), metastatic lymph node (LN) of the hepatic pedicle is a major prognostic factor. Efficiency of preoperative computed tomography (CT) and intraoperative examination for the diagnosis of metastatic LN of hepatic pedicle is prospectively evaluated.

Methods

From January 2008 to June 2010, 76 patients underwent liver resection for CRLM, with systematic LN pedicle dissection. Preoperative CT scan evaluated prospectively location, size, and aspect of LN, whereas the surgeon assessed size and consistency of LN Results of CT and intraoperative findings were compared with pathologic findings to determine sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).

Results

A total of 241 nodes were analyzed (3.2 ± 2.1 LN per patient). Systematic LN dissection increased the operative time by a mean of 20 ± 12.5 min, without any specific morbidity or mortality related to the LN clearance. Metastatic LN in the hepatic pedicle was observed in 15 (20%) patients and were unrelated to the number, size, and location of CRLM. NPV and PPV of the preoperative CT scan was 85 and 56%, respectively. Intraoperative evaluation of LN had a high NPV of 91% with a low PPV of 43%. Even with the combination of CT and intraoperative evaluation, 27% of the patients with a pathological metastatic LN were not suspected.

Conclusions

Because neither the preoperative CT nor the surgical evaluation accurately predicts metastatic LN in the hepatic pedicle, accurate oncological staging require a systematic pedicular LN clearance during liver resection for CRLM.

Keywords

Lymph Node Dissection Liver Resection Positive Predictive Value Negative Predictive Value Metastatic Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest

No conflict of interest exists.

References

  1. 1.
    Adam R, Pascal G, Azoulay D, et al. Liver resection for colorectal metastases: the third hepatectomy. Ann Surg. 2003;238:871–83.PubMedCrossRefGoogle Scholar
  2. 2.
    Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol. 1997;15:938–46.PubMedGoogle Scholar
  3. 3.
    Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients—Association Française de Chirurgie. Cancer. 1996;77:1254–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Jonas S, Thelen A, Benckert C, et al. Extended resections of liver metastases from colorectal cancer. World J Surg. 2007;31:511–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Adam R, de Haas RJ, Wicherts DA, et al. Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol. 2008;26:3672–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Jaeck D, Nakano H, Bachelier P, et al. Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study. Ann Surg Oncol. 2002;9:430–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Beckurts K, Holscher A, Thorban ST, et al. Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases. Br J Surg. 1997;84:1081–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Elias D, Ouellet JF, Bellon N, et al. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg. 2003;90:567–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Bennett J, Schmidt CR, Klimstra DS, et al. Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases. Ann Surg Oncol. 2008;15:1130–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Kokudo N, Sato T, Seki M, et al. Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer. Dis Colon Rectum. 1999;42:1285–91.PubMedCrossRefGoogle Scholar
  11. 11.
    Laurent C, Sa Cunha A, Rullier E, et al. Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis. J Am Coll Surg. 2004;198:884–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Elias DM, Ouellet JF. Incidence, distribution and significance of hilar lymph node metastases in hepatic colorectal metastases. Surg Oncol Clin North Am. 2003;12:221–9.CrossRefGoogle Scholar
  13. 13.
    Grobmyer SR, Wang L, Gonen M, et al. Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy. Ann Surg. 2006;244:260–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Nakamura S, Yokoi Y, Suzuki S, et al. Results of extensive surgery for liver metastases in colorectal carcinoma. Br J Surg. 1992;79:35–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Elias D, Saric J, Jaeck D. Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases. Br J Surg. 1996;83:942–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Ercolani G, Grazi GL, Ravaioli M, et al. The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg. 2004;239:202–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Nordlinger B, Sorbye H, Glimelius B. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomized controlled trial. Lancet. 2008;371:1007–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Oussoultzoglou E, Romain B, Panaro F, et al. Long-term survival after liver resection for colorectal liver metastases in patients with hepatic pedicle lymph nodes involvement in the era of new chemotherapy regimens. Ann Surg. 2009;249:879–86.PubMedCrossRefGoogle Scholar
  19. 19.
    Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastasis from colorectal cancer. Long-term results. Ann Surg. 2000;231:487–99.PubMedCrossRefGoogle Scholar
  20. 20.
    Sano T, Kobori O, Nagawa H, et al. The macroscopic diagnosis of lymph node metastasis from early gastric cancer. Surg Today. 1994;24:37–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Korenaga D, Okuyama T, Orita H, et al. Role of intraoperative assessment of lymph node metastasis and serosal invasion in patients with gastric cancer. J Surg Oncol. 1994;55:250–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Takeuchi H, Maehara Y, Kawano T, et al. Intraoperative assessment of lymph node metastasis for colorectal carcinoma. Int Surg. 1998;83:336–9.PubMedGoogle Scholar
  23. 23.
    Dighe S, Blake H, Koh DM. Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer. Br J Surg. 2010;97:1407–15.PubMedCrossRefGoogle Scholar
  24. 24.
    Yun M, Lim JS, Noh SH, et al. Lymph node staging of gastric cancer using 18F-FDG PET: a comparison study with CT. J Nucl Med. 2005;46:1582–8.PubMedGoogle Scholar
  25. 25.
    Bellomi M, Bonomo G, Landoni F, et al. Accuracy of computed tomography and magnetic resonance imaging in the detection of lymph node involvement in cervix carcinoma. Eur Radiol. 2005;15:2469–74.PubMedCrossRefGoogle Scholar
  26. 26.
    Ng S, Yen TC, Chang JTC, et al. Prospective study of [18F] fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol. 2006;24:4371–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Kato H, Kuwano H, Nakajima M, et al. Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer. 2002;94:921–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Shim SS, Lee KS, Kim BT, et al. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology. 2005;236:1011–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Dorfman R, Alpern M, Gross B. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology. 1991;180:319–22.PubMedGoogle Scholar
  30. 30.
    Koh DM, Hughes M, Husband JE. Cross-sectional imaging of nodal metastases in the abdomen and pelvis. Abdom Imaging. 2006;31:632–43.PubMedCrossRefGoogle Scholar
  31. 31.
    Imai H, Doi R, Kanazawa H, et al. Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol. 2010;15:294–300.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Cédric Rau
    • 1
    • 2
  • Benjamin Blanc
    • 1
    • 2
  • Maxime Ronot
    • 2
    • 3
  • Safi Dokmak
    • 1
    • 2
  • Béatrice Aussilhou
    • 1
    • 2
  • Sandrine Faivre
    • 2
    • 4
  • Valérie Vilgrain
    • 2
    • 3
  • Valérie Paradis
    • 2
    • 5
  • Jacques Belghiti
    • 1
    • 2
  1. 1.Department of HPB SurgeryBeaujon HospitalClichyFrance
  2. 2.Assistance Publique-Hôpitaux de ParisUniversity of Denis Diderot Paris 7ParisFrance
  3. 3.Department of RadiologyBeaujon HospitalClichyFrance
  4. 4.Department of OncologyBeaujon HospitalClichyFrance
  5. 5.Department of PathologyBeaujon HospitalClichyFrance

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