A surgically treated case of hepatocellular carcinoma with extensive lymph node metastases

A 62-year-old man with chronic hepatitis C was found to have a hepatic tumor by ultrasonography. Computed tomography of the liver disclosed a tumor 4 cm in diameter occupying the posterior segment and associated with a portal tumor thrombus and enlargement of hilar and paraaortic lymph nodes. At laparotomy multiple nodal metastases were seen involving hilar, hepatoduodenal, common hepatic arterial, and paraaortic nodes. We performed right hepatic lobectomy and systematic lymph node dissection. Histologic examination of both the main tumor and nodal metastases showed poorly-differentiated hepatocellular carcinoma. Severe postoperative ascites persisted for 1 month. Fifteen months after surgery the patient died of multiple intrahepatic and systemic nodal recurrences. Our experience confirms that surgical treatment of hepatocellular carcinoma with nodal metastases is likely to benefit only a few carefully selected patients, since the prognosis is commonly poor and hepatectomy with lymph node dissection carries the risk of severe complications.