Top

Published in:

01-09-2015 | Original Article

Clinical significance of surgical resection of metastatic lymph nodes from hepatocellular carcinoma

Authors: Yoshito Tomimaru, Hiroshi Wada, Hidetoshi Eguchi, Akira Tomokuni, Naoki Hama, Koichi Kawamoto, Shigeru Marubashi, Koji Umeshita, Yuichiro Doki, Masaki Mori, Kenichi Wakasa, Hiroaki Nagano

Published in: Surgery Today | Issue 9/2015

Abstract

Purpose

The clinical significance of the surgical resection of metastatic lymph nodes (LN) from patients with hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to evaluate the significance of the surgical resection of LN metastasis of HCC.

Methods

Among 961 patients who underwent surgical resection for HCC in our hospital, LN metastasis was identified in 38 patients. In these patients, the metastatic LN were removed completely in 22 patients (complete removal group), and incompletely or not removed in 16 patients (control group). The long-term prognosis after LN metastasis was compared between the two groups.

Results

The overall survival rate after LN metastasis was significantly better in the complete removal group (1-, 3- and 5-year: 71.2, 58.0 and 49.7 %, respectively) than in the control group (45.9, 23.0 and 15.3 %, respectively, p = 0.0477). LN metastasis was not the cause of death in any of the patients in the complete removal group, whereas it was a cause in some patients in the control group. No local LN recurrence was identified in the complete removal group.

Conclusions

The present results suggest that the complete removal of metastatic LN from HCC is clinically beneficial in selected patients.

Arii S, Monden K, Niwano M, Furutani M, Mori A, Mizumoto M, Imamura M. Results of surgical treatment for recurrent hepatocellular carcinoma; comparison of outcome among patients with multicentric carcinogenesis, intrahepatic metastasis, and extrahepatic recurrence. J Hepatobiliary Pancreat Surg. 1998;5(1):86–92.CrossRefPubMed

El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340(10):745–50.CrossRefPubMed

Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg. 2001;234(1):63–70.PubMedCentralCrossRefPubMed

Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg. 2003;238(5):703–10.PubMedCentralCrossRefPubMed

Nagao T, Inoue S, Goto S, Mizuta T, Omori Y, Kawano N, Morioka Y. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg. 1987;205(1):33–40.PubMedCentralCrossRefPubMed

Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K. Percutaneous radiofrequency ablation therapy with combined angiography and computed tomography assistance for patients with hepatocellular carcinoma. Cancer. 2001;91(7):1342–8.CrossRefPubMed

Kobayashi T, Ishiyama K, Ohdan H. Prevention of recurrence after curative treatment for hepatocellular carcinoma. Surg Today. 2013;43(12):1347–54.CrossRefPubMed

Ueno M, Hayami S, Tani M, Kawai M, Hirono S, Yamaue H. Recent trends in hepatectomy for elderly patients with hepatocellular carcinoma. Surg Today. 2014;44(9):1651–9.CrossRefPubMed

Nagano H, Miyamoto A, Wada H, Ota H, Marubashi S, Takeda Y, Dono K, Umeshita K, Sakon M, Monden M. Interferon-alpha and 5-fluorouracil combination therapy after palliative hepatic resection in patients with advanced hepatocellular carcinoma, portal venous tumor thrombus in the major trunk, and multiple nodules. Cancer. 2007;110(11):2493–501.CrossRefPubMed

10.

Nagano H, Sakon M, Eguchi H, Kondo M, Yamamoto T, Ota H, Nakamura M, Wada H, Damdinsuren B, Marubashi S, et al. Hepatic resection followed by IFN-alpha and 5-FU for advanced hepatocellular carcinoma with tumor thrombus in the major portal branch. Hepatogastroenterology. 2007;54(73):172–9.PubMed

11.

Ota H, Nagano H, Sakon M, Eguchi H, Kondo M, Yamamoto T, Nakamura M, Damdinsuren B, Wada H, Marubashi S, et al. Treatment of hepatocellular carcinoma with major portal vein thrombosis by combined therapy with subcutaneous interferon-alpha and intra-arterial 5-fluorouracil; role of type 1 interferon receptor expression. Br J Cancer. 2005;93(5):557–64.PubMedCentralCrossRefPubMed

12.

Sakon M, Nagano H, Dono K, Nakamori S, Umeshita K, Yamada A, Kawata S, Imai Y, Iijima S, Monden M. Combined intraarterial 5-fluorouracil and subcutaneous interferon-alpha therapy for advanced hepatocellular carcinoma with tumor thrombi in the major portal branches. Cancer. 2002;94(2):435–42.CrossRefPubMed

13.

Yang Y, Nagano H, Ota H, Morimoto O, Nakamura M, Wada H, Noda T, Damdinsuren B, Marubashi S, Miyamoto A, et al. Patterns and clinicopathologic features of extrahepatic recurrence of hepatocellular carcinoma after curative resection. Surgery. 2007;141(2):196–202.CrossRefPubMed

14.

Ercolani G, Grazi GL, Ravaioli M, Grigioni WF, Cescon M, Gardini A, Del Gaudio M, Cavallari A. The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg. 2004;239(2):202–9.PubMedCentralCrossRefPubMed

15.

Sun HC, Zhuang PY, Qin LX, Ye QH, Wang L, Ren N, Zhang JB, Qian YB, Lu L, Fan J, et al. Incidence and prognostic values of lymph node metastasis in operable hepatocellular carcinoma and evaluation of routine complete lymphadenectomy. J Surg Oncol. 2007;96(1):37–45.CrossRefPubMed

16.

Watanabe J, Nakashima O, Kojiro M. Clinicopathologic study on lymph node metastasis of hepatocellular carcinoma: a retrospective study of 660 consecutive autopsy cases. Jpn J Clin Oncol. 1994;24(1):37–41.PubMed

17.

Yuki K, Hirohashi S, Sakamoto M, Kanai T, Shimosato Y. Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer. 1990;66(10):2174–9.CrossRefPubMed

18.

Abe T, Furuse J, Yoshino M, Kinoshita T, Konishi M, Inoue K, Hasebe T. Clinical characteristics of hepatocellular carcinoma with an extensive lymph node metastasis at diagnosis. Am J Clin Oncol. 2002;25(3):318–23.CrossRefPubMed

19.

Une Y, Misawa K, Shimamura T, Ogasawara K, Masuko Y, Sato N, Nakajima Y, Uchino J. Treatment of lymph node recurrence in patients with hepatocellular carcinoma. Surg Today. 1994;24(7):606–9.CrossRefPubMed

20.

Zeng ZC, Tang ZY, Fan J, Qin LX, Ye SL, Zhou J, Sun HC, Wang BL, Wang JH. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factors from 125 patients. Int J Radiat Oncol Biol Phys. 2005;63(4):1067–76.CrossRefPubMed

21.

Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954;7(3):462–503.CrossRefPubMed

22.

Marsh JW, Dvorchik I, Bonham CA, Iwatsuki S. Is the pathologic TNM staging system for patients with hepatoma predictive of outcome? Cancer. 2000;88(3):538–43.CrossRefPubMed

23.

Toyoda H, Fukuda Y, Koyama Y, Nishimura D, Hoshino H, Katada N, Kato K, Hayakawa T. Case report: multiple systemic lymph node metastases from a small hepatocellular carcinoma. J Gastroenterol Hepatol. 1996;11(10):959–62.CrossRefPubMed

24.

Park YJ, Lim do H, Paik SW, Koh KC, Lee JH, Choi MS, Yoo BC, Nam HR, Oh DR, Park W, et al. Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma. J Gastroenterol. 2006;41(11):1099–1106.

25.

Yamashita H, Nakagawa K, Shiraishi K, Tago M, Igaki H, Nakamura N, Sasano N, Siina S, Omata M, Ohtomo K. Radiotherapy for lymph node metastases in patients with hepatocellular carcinoma: retrospective study. J Gastroenterol Hepatol. 2007;22(4):523–7.CrossRefPubMed

26.

Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10(1):25–34.CrossRefPubMed

27.

Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378–90.CrossRefPubMed

28.

Nakamura M, Nagano H, Marubashi S, Miyamoto A, Takeda Y, Kobayashi S, Wada H, Noda T, Dono K, Umeshita K, et al. Pilot study of combination chemotherapy of S-1, a novel oral DPD inhibitor, and interferon-alpha for advanced hepatocellular carcinoma with extrahepatic metastasis. Cancer. 2008;112(8):1765–71.CrossRefPubMed

29.

Nakamura M, Nagano H, Wada H, Noda T, Ota H, Damdinsuren B, Marubashi S, Miyamoto A, Takeda Y, Umeshita K, et al. A case of hepatocellular carcinoma with multiple lung, spleen, and remnant liver metastasis successfully treated by combination chemotherapy with the novel oral DPD-inhibiting chemotherapeutic drug S-1 and interferon-alpha. J Gastroenterol. 2006;41(11):1120–5.CrossRefPubMed

30.

Uenishi T, Hirohashi K, Shuto T, Kubo S, Tanaka H, Sakata C, Ikebe T, Kinoshita H. The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma. Surg Today. 2000;30(10):892–5.CrossRefPubMed

31.

Lau WY, Leung TW, Leung KL, Ho S, Leung N, Chan M, Lin J, Li AK. Cytoreductive surgery for hepatocellular carcinoma. Surg Oncol. 1994;3(3):161–6.CrossRefPubMed

32.

Yamamoto K, Takenaka K, Kawahara N, Shimada M, Shirabe K, Itasaka H, Nishizaki T, Yanaga K, Sugimachi K. Indications for palliative reduction surgery in advanced hepatocellular carcinoma. The use of a remnant tumor index. Arch Surg. 1997;132(2):120–3.CrossRefPubMed

33.

Miller DL, Katz NM, Pallas RS. Hepatoma presenting as a right atrial mass. Am Heart J. 1987;114(4 Pt 1):906–8.CrossRefPubMed

Title: Clinical significance of surgical resection of metastatic lymph nodes from hepatocellular carcinoma
Authors: Yoshito Tomimaru
Hiroshi Wada
Hidetoshi Eguchi
Akira Tomokuni
Naoki Hama
Koichi Kawamoto
Shigeru Marubashi
Koji Umeshita
Yuichiro Doki
Masaki Mori
Kenichi Wakasa
Hiroaki Nagano
Publication date: 01-09-2015
Publisher: Springer Japan
Published in: Surgery Today / Issue 9/2015
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-014-1028-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical significance of surgical resection of metastatic lymph nodes from hepatocellular carcinoma

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2015

Pericardial ectopic thymoma presenting with cardiac tamponade: report of a case

Pulmonary chondromatous hamartoma with pleural dissemination: report of a case

Surgical outcomes of pulmonary metastases from esophageal carcinoma diagnosed by both pathological and clinical criteria

Off-pump coronary artery bypass grafting via median sternotomy in a patient with a history of esophagectomy with substernal gastric tube reconstruction: report of a case

Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

Blood supply of the terminal part of the external branch of the superior laryngeal nerve