Incidence, distribution, and significance of hilar lymph node metastases in hepatic colorectal metastases.

For many surgeons, the presence of HLNM has been a formal contraindication to resection of LM from colorectal cancer. This attitude is based on the very poor survival seen in small subgroups of patients with HLNM who have been included in large-scale studies of patients with LM. The incidence of macroscopic HLNM in patients with LM has been reported at 1% to 12%. In the authors' experience, the rate of macroscopic HLNM is 7% and the incidence of macroscopic and microscopic HLNM is 19%. The reported 5-year survival rate of patients with resected HLNM is generally poor (12%), although this article reports a study with a 5-year overall survival rate of 27%. The authors do not recommend routine hilar lymph node biopsy and frozen section for all patients with LM undergoing resection; however, they do recommend a systematic palpation of hepatoduodenal lymph nodes with frozen section of suspicious lymphadenopathy prior to resection. In cases of proven HLNM, combined liver resection and lymphadenectomy could be considered in selected patients. This selection should be performed on an individual basis guided by the absence of important comorbid condition, the biology of the disease, and the surgeon's judgment that this is limited hilar lymphatic involvement without other sites of extrahepatic disease. Systematic routine en bloc lymphadenectomy currently has no prognostic value and no known therapeutic effects.