Extracapsular Lymph Node Involvement is Associated With Colorectal Liver Metastases and Impact Outcome After Hepatectomy for Colorectal Metastases

Background Hepatic resection of metastatic colorectal cancer (CRC) has become the treatment of choice for patients after resection of the primary CRC. However, some patients do not benefit from immediate resection because of rapidly progressive disease. The aim of this study was to examine the prognostic value of extracapsular invasion (ECI) of lymph node (LN) metastasis of CRC with liver metastases following liver resection. Methods All patients who underwent resection for CRC with liver metastases between 1995 and 2011 were reviewed. All of those with metastasis from primary CRC were included in this study. Preoperative, intraoperative, and postoperative data, including primary tumor pathology results, were retrospectively reviewed. All resected LNs from primary CRC were re-examined to assess ECI. Associations between clinicopathologic factors, survival, and the nodal findings were evaluated. Results ECI was identified in 47 (48 %) patients. ECI was correlated with the number of positive LNs ( p = 0.0022), timing of liver metastasis ( p = 0.0238), and number of liver metastases ( p = 0.0001). Univariate analysis indicated that the number of positive LNs ( p = 0.0014), ECI ( p = 0.0203), and adjuvant chemotherapy ( p = 0.0423) were significant prognostic factors. Patients with ECI had a significantly worse survival ( p = 0.0024) after liver resection than patients with LN-negative and ECI-negative groups. Conclusions In patients with hepatic CRC metastases, ECI in regional LNs reflects a particularly aggressive behavior, such as a greater number of liver metastases. In CRC patients with liver metastases, ECI in regional LNs might be correlated with poor prognosis following liver resection.