In Reply: Partial Hepatectomy for Colorectal Metastases and Perihepatic Lymph Node Micrometastases

摘要

We appreciate Dr. Pandey's thoughtful comments on our article. As he remarks, it is encouraging that 3-year overall survival is 25% even for those patients with metastatic disease to perihepatic lymph nodes discovered by hematoxylin and eosin (H&E) staining after hepatectomy. Whether these lymph node deposits represent metastasis derived from the primary colorectal tumor or the liver tumors is uncertain. Dr. Pandey's statement that metastasis in perihepatic nodes derived from the primary tumor indicates more aggressive tumor biology is debatable. Indeed, perihepatic lymph node metastasis arising from liver tumors may be more virulent given that the disease in the liver already has proven metastatic potential. Furthermore, there is ample data in the literature demonstrating that presence of tumors in perihepatic nodes is a poor prognostic sign. We eagerly await molecular data which might further settle this question.