Infiltration of lymph nodes in the hepatoduodenal ligament is the most important prognostic factor following R0 resection of colorectal liver metastases.

Infiltration of lymph nodes in the hepatoduodenal ligament is the most important prognostic factor following R0 resection of colorectal liver metastases.

Long-term results in 217 patients with carcinoma of the cardia were analysed prospectively. 43 of the 217 could not be operated upon, either because of their poor general condition (51%), distal metastases (49%), and (or) the primary tumour having advanced too far locally (9%). Two of the 176 patients proved to be inoperable at surgery so that only 174 underwent resection (operation rate 81%; resection rate 99%). The operation risk was no higher for advanced tumour (T3/T4) than for earlier tumour stages (T1/T2). The tumour was completely resected macroscopically and microscopically (R0 resection) in 59% of patients in stage T4. Their median survival time was significantly higher than that for patients with local lymph-node spread (12.5 vs 6.0 months; P less than 0.01). Those patients who endoscopically received palliative treatment had a median survival time of 5 months. These results suggest that resection of locally advanced carcinoma of the cardia is worth while, if the tumour can be removed completely both macroscopically and microscopically (R0 resection).