Is surgical resection justified in colorectal liver metastasis with synchronous metastasis in lymph nodes of hepatoduodenal ligament (group 12)

Colorectal cancer (CRC) is one of the most common malignancies worldwide. Most CRC metastases are found in the liver. Although metastasectomy of liver metastases might be curative, the role of hepatic lymph node dissection remains unclear. The purpose of this study is to understand the effect of portal lymph node dissection in addition to metastasectomy on long-term outcomes. Overall, 2353 patients with liver metastasis were identified during the study period. Among them, 38 patients with positive lymph nodes were identified. 28.9% (n=11) of lymph nodes were found to be positive on final pathologic examination. Average follow-up was 24.2 (0.1–60.9) months. Median progression-free survival for patients with proven positive lymph nodes was 7 months, and 26 months in patients with negative lymph nodes (95% CI of ratio 0.03872 to 0.5772, p=0.5108, HR=1.568), which was not statistically significant. Median overall survival was 28.5 (0.1-61). Patients with positive portal lymph nodes had a median overall survival of 9 months, compared with those with negative lymph nodes, but this difference was not statistically significant. We found that resection of lymph nodes of the 8th and 12th groups does not worsen surgical outcomes, but it also does not improve oncological outcomes. Overall, surgical treatment of liver metastases should be considered as a part of treatment intent for patients with metastatic colorectal cancer, but the presence of enlarged lymph nodes of the hepato-duodenal ligament should be assessed as a negative prognostic factor; this risk has to be taken into consideration. Further studies are required to assess whether this method is better compared to systemic therapy.