BACKGROUND: The pattern of lymphatic spread of ampullary cancer is poorly documented. This pattern was clarified in order to define the rational extent of radical lymphadenectomy. METHOD: Thirty-nine consecutive patients who underwent pancreaticoduodenectomy with radical lymphadenectomy were included in the study. A total of 1447 lymph nodes dissected from the resected specimens was examined to detect the presence of metastatic foci. RESULTS: Twenty-one of the 39 patients had a total of 97 positive nodes. The sites of nodal involvement were the posterior pancreaticoduodenal (20 of 21 patients), inferior pancreaticoduodenal artery (IPDA; 12 of 21), anterior pancreaticoduodenal (three of 21), trunk of the superior mesenteric artery (three of 20), pericholedochal (three of 21), retroportal (two of 21), and para-aortic (three of five) regions. No metastases were found in the hepatic artery, cystic duct, perigastric, right coeliac, middle colic artery or right caval node groups. CONCLUSION: Ampullary cancer mainly spreads to the posterior pancreaticoduodenal node group, then to the IPDA node group, and finally to the para-aortic area. The rational extent of radical lymphadenectomy should include the pancreaticoduodenal, superior mesenteric, pericholedochal, retroportal and para-aortic nodes.
BACKGROUND: The pattern of lymphatic spread of ampullary cancer is poorly documented. This pattern was clarified in order to define the rational extent of radical lymphadenectomy. METHOD: Thirty-nine consecutive patients who underwent pancreaticoduodenectomy with radical lymphadenectomy were included in the study. A total of 1447 lymph nodes dissected from the resected specimens was examined to detect the presence of metastatic foci. RESULTS: Twenty-one of the 39 patients had a total of 97 positive nodes. The sites of nodal involvement were the posterior pancreaticoduodenal (20 of 21 patients), inferior pancreaticoduodenal artery (IPDA; 12 of 21), anterior pancreaticoduodenal (three of 21), trunk of the superior mesenteric artery (three of 20), pericholedochal (three of 21), retroportal (two of 21), and para-aortic (three of five) regions. No metastases were found in the hepatic artery, cystic duct, perigastric, right coeliac, middle colic artery or right caval node groups. CONCLUSION: Ampullary cancer mainly spreads to the posterior pancreaticoduodenal node group, then to the IPDA node group, and finally to the para-aortic area. The rational extent of radical lymphadenectomy should include the pancreaticoduodenal, superior mesenteric, pericholedochal, retroportal and para-aortic nodes.
Authors: Andrea Di Giorgio; Sergio Alfieri; Fabio Rotondi; Francesco Prete; Dario Di Miceli; Marco Pericoli Ridolfini; Fausto Rosa; Marcello Covino; Giovanni Battista Doglietto Journal: World J Surg Date: 2005-04 Impact factor: 3.352