Abstract
To clarify the indications for pylorus-preserving pancreatoduodenectomy (PpPD) in patients with cancer in the pancreatic head region, we evaluated the state of lymph node metastasis and paragastric lymph node metastasis in 56 patients with cancer in the pancreatic head region. They underwent D2 or more extensive lymph node dissection and were adequately examined by postoperative histopathological examination during the past 16-year period. Lymph node metastasis was frequently observed in patients with pancreatic head cancer of the infiltrative type and duodenal infiltration, those with cancer of the papilla of Vater of the ulcerative tumor type and pancreatic infiltration, and those with distal bile duct cancer of the infiltrative type and pancreatic infiltration. According to the histological type, patients with moderately to poorly differentiated cancer frequently had lymph node metastasis. Paragastric lymph node metastasis was observed in three patients with pancreatic head cancer and one with distal bile duct cancer, but none with cancer of the papilla of Vater. All three patients with pancreatic cancer showed the infiltrative type and infiltration to the second part of the duodenum. The patient with distal bile duct cancer showed the nodular infiltrative type and poorly differentiated cancer. No direct infiltration of cancer to the first part of the duodenum or the stomach was observed. These results suggest that the indications for PPPD are pancreatic head cancer not accompanied by duodenal infiltration, cancer of the papilla of Vater, and distal bile duct cancer not accompanied by pancreatic infiltration.
