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Regional lymph node sampling in hepatoma resection: insight into prognosis
John R Bergquist1, Amy Y Li2, Christopher S Javadi1
1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Stanford University, Stanford, CA, USA.
Summary
Regional lymph node sampling (LNS) during liver resection for hepatocellular carcinoma (HCC) is uncommon but offers crucial prognostic insights. Despite similar survival rates between patients with and without LNS, node positivity significantly impacts outcomes, guiding multidisciplinary care.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Cancer research
Background:
- The role of regional lymph node sampling (LNS) in hepatocellular carcinoma (HCC) resection remains unclear.
- This study addresses this knowledge gap using a large-scale, population-based dataset.
Purpose of the Study:
- To investigate the significance and impact of regional lymph node sampling (LNS) in patients undergoing liver resection for HCC.
- To evaluate the prognostic value of LNS and its effect on survival outcomes.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER-18) database (2003-2015) to identify patients who underwent liver resection (LR) for HCC.
- Employed propensity-score matching for cohort comparisons based on LNS completion, analyzing overall and disease-specific survival (OS/DSS).
Main Results:
- Only 15.4% of 5395 HCC patients underwent LNS, often with larger tumors and higher T-stage.
- Node-positive patients (12.0%) demonstrated significantly decreased OS/DSS.
- Matched LNS and non-LNS cohorts showed similar survival, but node positivity remained a significant negative prognostic factor.
Conclusions:
- Regional LNS is infrequently performed in HCC resection but provides valuable prognostic information.
- Given the advent of adjuvant therapies, surgeons should consider LNS for enhanced multidisciplinary management of HCC.
