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Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy
Stephen R Grobmyer1, Liang Wang, Mithat Gonen
1Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Annals of Surgery
|July 22, 2006
Summary
Preoperative imaging (CT/PET) and clinical assessment are valuable for evaluating perihepatic lymph nodes in liver cancer patients. Routine sampling is low-yield unless imaging or clinical suspicion is positive.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Diagnostic imaging
Background:
- Perihepatic lymph node status is a critical prognostic factor in liver cancer resection.
- The diagnostic utility of preoperative imaging and intraoperative assessment of these nodes remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of preoperative imaging (CT, PET) and intraoperative clinical assessment in identifying perihepatic lymph node metastasis.
- To determine the value of routine perihepatic lymph node sampling during partial hepatectomy for liver malignancy.
Main Methods:
- 100 patients undergoing liver resection for primary or metastatic cancer had perihepatic lymph nodes sampled.
- Surgeons assigned a clinical suspicion score (1-5) for nodal involvement.
- Preoperative CT and PET scans were reviewed by radiologists; all data were correlated with pathological findings.
Main Results:
- PET scans demonstrated 100% positive predictive value for nodal metastasis.
- High negative predictive values were observed for clinical assessment (99%), CT (95%), and PET (88%).
- Only 2.1% of patients with negative CT and PET scans had metastatic nodal disease, often suspected clinically.
Conclusions:
- Occult metastatic disease in perihepatic lymph nodes is uncommon in liver cancer patients.
- Routine perihepatic lymph node sampling offers low yield when preoperative imaging and clinical assessment are negative.