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Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases

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Abstract

The liver is the most common site of distant metastases in patients with colorectal cancer. Surgery represents the mainstream for curative treatment of colorectal cancer liver metastases (CRCLM) with long-term survival up to 58 and 36 % at 5 and 10 years, respectively. Despite advances on diagnosis, staging and surgical strategies, 60–70 % of patients will develop recurrence of the disease even after R0 resection of CRCLM. Tumor staging, prognosis, and therapeutic approaches for cancer are most often based on the extent of involvement of regional lymph nodes (LNs) and, to a lesser extent, on the invasion of regional lymphatic vessels draining the primary tumor. For CRCLM, the presence of intra hepatic lymphatic and blood vascular dissemination has been associated with an increased risk of intra hepatic recurrence, poorer disease-free and overall survival after liver resection. Also, several studies have reviewed the role of surgery in the patient with concomitant CRCLM and liver pedicle LN metastasis. Although pedicle LN involvement is related to worst survival rates, it does not differentiate patients that will relapse from those that will not. This review aims to briefly describe the anatomy of the liver’s lymphatic drainage, the incidence of intrahepatic lymphatic invasion and hilar lymph node involvement, as well as their clinical impact in CRCLM. A better understanding of the role of liver lymphatic metastasis might, in the near future, impact the strategy of systemic therapies after liver resection as for primary colorectal tumors.

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Acknowledgments

The authors thank Marcos Retzer (graphic designer) who drawned figure 1.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Service de chirurgie Digestive, viscérale et endocrinienne, Groupe Hospitalier Diaconesses Croix-Saint-Simon, 125, rue d’Avron, 75020, Paris, France

    Renato Micelli Lupinacci

  2. Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil

    Renato Micelli Lupinacci, Fabricio Ferreira Coelho, Jaime Arthur Pirolla Kruger & Paulo Herman

  3. University Pierre et Marie Curie, Paris, France

    François Paye

  4. Department of Digestive Surgery, Hôpital Saint Antoine, Paris, France

    François Paye

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  1. Renato Micelli Lupinacci
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Lupinacci, R.M., Paye, F., Coelho, F.F. et al. Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases. Updates Surg 66, 239–245 (2014). https://doi.org/10.1007/s13304-014-0265-0

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