Abstract
We evaluated appropriate lymph node dissection according to local extension based on the state of lymph node metastasis in patients with the papilla of Vater who underwent resection.
The subjects consisted of 29 patients in whom adequate postoperative histopathological examination was performed. They were divided into three groups 8 patients with early cancer (extension limited to the sphincter of Oddi),6 with semi-early cancer (extension beyond the sphincter of Odii without infiltration to pancreatic parenchyma), and 15 with advanced cancer (infiltration to pancreatic parenchyma).
Lymph node metastasis was observed in 11 patients (37.9%): 1 (12.5%) with early cancer,2(33.3%) with semi-early cancer, and 8 (53.3%) with advanced cancer. The patients with early or semi-early cancer showed only metastasis to the first lymph node group. However, in those with advanced cancer, the first group was involved in 2 patients, the 2nd group in 2, and the 3rd group in 4.
Paraaortic lymph node metastasis (No.16b1) was frequently observed in patients showing a high proliferating cell nuclear antigen labelling index (PCNAL. I. ). Concerning to lymph node dissection according to cancer extension, we perform D1for early, D2for semi-early cancer and D3for advanced cancer, particularly paraaortic lymph node dissection for patients with a high PCNAL. I..
