Abstract
In distal cholangiocarcinoma, total lymph node count (TLNC) should be 10 or more. TLNC significantly affects postoperative survival in pN0 patients and this observation can be explained by stage migration. Although sampling of periaortic or perigastric node raises TLNC, these lymph nodes are treated as distant nodes and rarely involved. Among the regional lymph nodes, the metastatic incidence of nodes along the superior mesenteric artery (No. 14) is almost identical to that of nodes along the common hepatic artery. However, the number of No. 14 nodes retrieval is generally low with a median of only 1, suggesting that the manner of lymphadenectomy of No. 14 nodes should be systematically performed to maximize the number of node retrieval. For the sake, the inferior pancreatoduodenal artery and the first duodenal artery should be divided at the root; additionally, nodes on the left side of the superior mesenteric artery should be removed.
