Management of Lymph Nodes During Resection of Hepatocellular Carcinoma

Thanks, Gavin.

Hoping that my thoughts encourage a conversation.

Abstracts – what do we learn?
http://www.ncbi.nlm.nih.gov/pubmed/25300798

The entire study will be published in the Journal of Gastroenterology

434 patients with intrahepatic disease (abstract does not quantify hilar or distal)
Data was taken from PubMed, Cochrane, Embase, Scopus, and Web of Science databases. We know that it a retrospective study i.e. taken from cases already occurred.

Time span – we don’t know the dates of the data purged from the above mentioned sources.
Conclusion: There is not enough data to support routine removal of lymph nodes however; potentially there are indications that surgeons should consider it beneficial to patient

http://www.ncbi.nlm.nih.gov/pubmed/24027075 – Abstract
This study refers to data retrieved from PubMed
Time span: from 2000 to 2013
Data collected included: lymph node metastasis, rate of removal of lymph node and consideration was given to Institutional Policies (Institutions regulate and dictate whether lymph nodes can be removed._
Conclusion: Randomized clinical research studies should be conducted for more definite answers. This is the process in which researchers evenly assign study participants into a group receiving the experimental treatment being studied, and others into a group receiving standard or no treatment. Participants are assigned to a group based on chance, not choice.

http://www.ncbi.nlm.nih.gov/pubmed/24379635 – Abstract
124 intrahepatic patients had undergone surgery. (not stratified – hilar – distal)
Time span – January 2006 to December 2007
Curative surgeries was intended for all patients including those with suspicious metastases.
Patients with lymph nodes located between the porta haptis of the liver and lesser omentum were excluded from the study.
During surgery 53 patients had regional lymph nodes removed, including 11 patients with metastases to lymph nodes.
Even though the lymph nodes had metastasized, those patients resected with a singular tumor faired best with lymph node removal.
Patients with metastasized lymph nodes and those with more than one tumor may not benefit from routine aggressive lymph node removal. Based on that, the decision of aggressive lymph node removal should be made by the physician.

Any thoughts?

Hugs,
Marion