Slovenská chirurgia 1-2/2016
The significance of hepatoduodenal ligament lymphadenectomy during liver resection for metastatic colorectal cancer – new standard?
Approximately 25% of patients present with metastases at initial diagnosis and almost 50% of patients with colorectal cancer will develop metastases within two years of the initial diagnosis. Liver is the most common site of the metastatic disease. Primary resection is considered for approximately 20% of patients with colorectal liver metastasis. Surgery for isolated liver metastases from colorectal cancer has been accepted as the standard of care as it has proven to be life prolonging. The therapeutic algorithm is based on an assessment of operability and resectability. Systemic therapy has developed remarkably over the past few years. These improvements have increased the pool of patients who are being considered for resection of metastatic colorectal cancer. The presence of lymph node involvement was traditionally considered an absolute contraindication to resection, but there appears to be a role for surgery in highly selected patients with a single site of EHM amenable to complete resection. The unsolved questions are the impact and extent of lymphadenectomy during liver resection. Also the time of surgery. Unlike patients with liver disease only, however, the goals of surgery must not be viewed as potentially curative. Patients with lymph node involvement are consider as a group with a particularly poor outcome.
Keywords: lymphadenectomy, hepatoduodenal ligament, liver resection, colorectal cancer, survival and relapse
