RESUMEN
CONTEXT: Hepatectomy is the treatment of choice for colorectal liver metastases, and several studies have shown good results, with 5-year survival rates ranging from 40% to 57%. Several clinical and pathological predictive factors for survival after liver resection have been studied. Involvement of the hepatic hilum lymph nodes, the incidence of which varies from 2% to 10%, indicates a poor long-term prognosis. RESULTS: Despite variable results, some authors have reported a not-insignificant improvement in survival rate in liver-metastasis patients with hilar lymph node involvement who undergo combined liver resection and lymphadenectomy. Due to the low rates of morbidity and mortality for liver-resection surgery, several specialized centers perform liver resections combined with lymphadenectomies in selected cases. It should be noted that the therapeutic value of systemic lymphadenectomy is not yet entirely understood, and only controlled studies comparing groups with and without lymphadenectomy can fully resolve the issue. CONCLUSION: In any case, hilar lymph node dissection has been shown to be a useful tool for improving the accuracy of extra hepatic disease staging, regardless of its impact on survival.
Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Colorrectales/cirugía , Supervivencia sin Enfermedad , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , PronósticoRESUMEN
CONTEXT: Hepatectomy is the treatment of choice for colorectal liver metastases, and several studies have shown good results, with 5-year survival rates ranging from 40 percent to 57 percent. Several clinical and pathological predictive factors for survival after liver resection have been studied. Involvement of the hepatic hilum lymph nodes, the incidence of which varies from 2 percent to 10 percent, indicates a poor long-term prognosis. RESULTS: Despite variable results, some authors have reported a not-insignificant improvement in survival rate in liver-metastasis patients with hilar lymph node involvement who undergo combined liver resection and lymphadenectomy. Due to the low rates of morbidity and mortality for liver-resection surgery, several specialized centers perform liver resections combined with lymphadenectomies in selected cases. It should be noted that the therapeutic value of systemic lymphadenectomy is not yet entirely understood, and only controlled studies comparing groups with and without lymphadenectomy can fully resolve the issue. CONCLUSION: In any case, hilar lymph node dissection has been shown to be a useful tool for improving the accuracy of extra hepatic disease staging, regardless of its impact on survival.
CONTEXTO: A hepatectomia é o tratamento de eleição para metástases hepáticas de câncer colorretal e diversos estudos têm demonstrado bons resultados, com índices de sobrevida em 5 anos entre 40 por cento e 57 por cento. Vários fatores clínico-patológicos preditivos de sobrevida após a ressecção hepática têm sido estudados e o envolvimento linfonodal do hilo hepático, que varia entre 2 por cento e 10 por cento, confere a este grupo prognóstico reservado a longo prazo. RESULTADOS: Embora com resultados variáveis, alguns autores têm relatado sobrevida não desprezível em pacientes com metástases hepáticas associada à doença linfonodal hilar submetidos a hepatectomia conjuntamente à linfadenectomia. Muitos centros especializados, embasados nos baixos índices de morbimortalidade da hepatectomia, realizam a ressecção hepática associada à linfadenectomia em casos selecionados. Cumpre ressaltar que o valor terapêutico da linfadenectomia sistemática ainda não é inteiramente conhecido e somente estudos controlados, comparando grupos com e sem linfadenectomia, poderão dirimir estas questões. CONCLUSÃO: De qualquer forma, a dissecção linfonodal hilar demonstrou ser uma ferramenta que torna mais preciso o estadiamento da doença extra-hepática, independente do impacto deste procedimento na sobrevida.