Abstract
This study was performed to determine whether pancreatoduodenectomy (PD) is required to accomplish lymph node dissection in patients with advanced carcinoma of the gallbladder. Lymph nodes were extensively disseced from the tissue at the head of the pancreas in surgical materials obtained from 20 patients with gallbladder carcinoma who underwent PD. The persistence of lymph node Nos.13a,13b,17a, and 17b was studied histopathologically. Lymph nodes remained in the peripancreatic tissue in 16 of the 20 patients (80%). Among 55 lymph nodes less than 3 mm in diameter,39 (71%) remained in peripancreatic tissue even after extensive dissection. About 7% of node Nos.13,13b,17a, and 17b that were less than 3 mm in diameter were metastasis positive. Cancer remained in the peripancreatic tissue after extensive lymph node dissection in two patients, one with venous invasion and one with lymphatic invasion. PD was considered essential for the complete dissection of peripancreatic lymph nodes; this procedure is indispensable in patients with venous or lymphatic invasion.
