Abstract:

Objective

To investigate the related factors that effect on lymphonoid metastasis of liver cancer,pathway of lymphatic invasion,surgical procedures,postoperative adjuvant therapies and the prognosis of patients.

Methods

21 cases of liver cancer with lymphonoid metastasis were analyzed in this study,including the pathology of tumor,tumor invasion of regional lymph nodes,accordant rates of pre-and postoperative diagnosis,treatments,postoperative therapies and survival of the patients.

Results

The pathological diagnosis of liver cancer included:HCC in 12,cholangiocellular carcinoma in 5,mixed hepatoma and secondary liver cancer in 2 respectively.Liver tumor located in segment I,V,ⅤandⅧ,ⅤandⅥ,ⅦandⅧin 1 case respectively,segment II andⅢin 3,segmentⅡ-Ⅳin 6,VI andⅦin 5 and diffuse invasion in 2 cases.The average diameter of the tumor was 7.5 cm.Lymphonoid invasion was diagnosed preoperatively in 7 patients(33.4%),and the rest were diagnosed intraoperation(66.6%).The group 8 of lymph node was involved in 10 cases(47.6%),group 8 and 12 in 4(19%),more than 3 groups were invaded in 5(23.8%),and distal group 13 or 14 was singly involved in 1 respectively(9%).In addition,there were 3 cases of the 21 patients with tumor metastasis to gall bladder,extrahepatic bile duct and other tissues.In the 10 patients with more than 3 groups lymph nodes invasion or distal lymphatic and other tissue metastasis,3 were HCC(3/12),accounting for 25%of the HCC cases,3 were cholangiocellular carcinoma(3/5,60%),mixed liver caner and secondary liver cancer were 2 respectively(4/4,100%).Two cases of HCC were reoperated on due to tumor recurrence.The mean survival of the 21patients was 7.8 months,shortest 3months and longest 34 months.5 cases receiving postoperative chemotherapies survived more than 12 months.

Conclusion

It has been suggested from our study that the most prevalent invasion of lymph node in liver cancer is the group 8,about 91%(19/21).The severity of lymphatic involvement is related to the pathological pattern of the tumor.As the relatively high missdiagnostic rate preoperation,it should be emphasized that careful preoperative assessment of clinical data and intraoperative exploration(especially the lymph node of group 8)are needed.Resection of the implicated lymph nodes and postoperative adjuvant therapies will be of benefit for the patients to improve the prognosis.Because it is rather difficult to remove the involved lymph nodes,it is necessary for a surgeon to master the essential technique of lymphatic resection.

Key words: liver cancer, lymph nodes, metastasis, diagnosis, surgical treatment