This study examined the impact of cancer that has spread to the liver and the lymph nodes surrounding the liver (hepatic hilar lymph node [HLN] metastasis) on patient survival.

The liver is the most common organ for distant metastasis in patients with colorectal cancer. It is a poor prognostic factor for patients, especially if left untreated. However, surgical removal of the affected liver area can potentially cure patients and allow for long-term survival.

For patients who have liver metastasis it is also possible for the cancer to spread to surrounding lymph nodes (HLN metastasis). This is considered to be one of the worst prognostic factors for patients and initially meant that liver surgery would not be carried out (contraindication for liver resection). Improvements in the treatment of liver metastasis means that it may now be possible to perform liver surgery (in combination with chemotherapy) in patients with HLN metastasis.

This study included 73 patients with liver metastasis who also underwent surgical removal of the liver lymph nodes as they were at high risk for HLN metastasis. Patient data, surgical outcome and prognosis after the surgery was compared in patients with HLN metastasis and those who did not.

Of the 73 patients who had surgery 16.4% of patients (12 patients) had HLN metastasis. There were no significant differences in the patient characteristics including age, gender or location of the primary tumor for patients with and without HLN metastasis. There were also no differences in the characteristics of the liver metastasis including the number of liver tumors, the size of the tumors or the location of the tumors for patients with and without HLN metastasis.

The 5-year overall survival rate was 37.1% for patients without HLN metastasis, compared to 16.2% for patients with HLN metastasis. After 5 years 32.9% of patients without HLN metastasis remained disease free compared to none of the patients with HLN metastasis.

Statistical analysis revealed that having cancer positive hepatic hilar lymph nodes increased the odds of death for patients with liver metastasis by 72.5%.

The authors concluded that liver surgery with simultaneous removal of the hepatic hilar lymph nodes might offer a unique curative opportunity for colorectal patients with liver metastasis plus HLN metastasis.

This was a relatively small retrospective study (the data was retrieved from patient records). Further research should be carried out to support these findings.