Abstract
The pattern of tumor spread and mode of recurrence of carcinoma of the pancreatic head area were investigated by clinicopathologic analysis for the preservation of superior mesenteric pleuxus. One hundred and thirty three patients with carcinoma of the pancreatic head area were examined histopath-ologically. These patients consisted of 70 with carcinoma of the head of the pancreas (Ph), 31 with distal bile duct cancer (Bi), and 32 with carcinoma of the papilla of Vater (A). Fifty-five (79%) of the patients with “Ph” disease, 21 (67%) of those with “Bi” disease, and 14 (44%) of those with “A” disease had nodal involvement. Frequencies of No.14 lymph node metastasis were 34%. 32%, and 16% respectively Extrapancreatic plexus invasion by these three carcinomas was observed in 60% of “Ph”, 26% of “Bi”, and 3% of “A” patients. Retroperitoneal recurrence including paraaortic lymph nodes was discovered in 88% of the patients with “Ph” who had undergone macroscopically curative resection. All six “Bi” patients with recurrence among patients who underwent curative resection had retroperitoneal recurrence. These results indicate that complete dissection including paraaortic lymph nodes and the extrapan-creatic plexus is necessary for carcinoma of the head of the pancreas. It is possible to perform nodal dissection around the supperior mesenteric artery while preserving the nerve plexus for patients without far advanced distal bile duct cancer or carcinoma of the papilla of Vater.
