Surgical treatment of lymph node metastases from hepatocellular carcinoma

No consensus has been reached on the feasibility and efficacy of surgery for lymph node metastases (LNM) from hepatocellular carcinoma (HCC). Of 2189 patients with HCC treated at our hospital between July 1992 and March 2008, we retrospectively reviewed the medical dossiers of the 18 patients (0.8%) who underwent lymph node resection and were pathologically diagnosed to have LNM from HCC. The surgical procedure for LNM was selective lymphadenectomy of those lymph nodes suspected to harbor metastasis. The feasibility and efficacy of selective lymphadenectomy was examined, and clinicopathological factors were analyzed with the aim of determining which patients would most benefit from surgery. Eighteen patients underwent surgery without mortality or liver failure. Morbidities were found in four patients (22.2%). The median survival time (MST) after surgery was 29 months [95% confidence interval (CI) 21-38 months). The 1-, 3-, and 5-year overall survival rates were 85, 42, 21%. The median progression-free survival (PFS) after surgery was 6 months (95% CI 1-11 months), and the median extrahepatic PFS was 16 months (95% CI 13-18 months). Single LNM was the only favorable prognostic factor after surgery (Hazard ratio 0.082, 95% CI 0.008-0.83). Selective lymphadenectomy of LNM from HCC was a feasible and efficacious procedure. Survival rates can be expected to improve after selective lymphadenectomy of single LNM.