Lymphadenectomy of the hepatic pedicle during hepato-pancreato-biliary surgery

Nodal involvement of the hepatic pedicle is variable and depends on the underlying hepato-bilio-pancreatic pathology. Although its value for ultimate prognosis has not been demonstrated, lymphadenectomy is usually performed to determine tumor stage and to inform the decision about eventual adjuvant treatment. Lymph node dissection of the hepatic pedicle requires a thorough understanding of the anatomy of hepatic lymphatic drainage as well as accurate analysis of pre-operative imaging in order to identify and locate abnormal lymph and to rule out anatomical variations that might complicate the surgical procedure.