A Case of Gallbladder Carcinoma Presenting Metastasis to Paracaval Lymph Nodes

Yoshio Shirai, Keisuke Yoshida, Kazuhiro Tsukada, Katsuyuki Uchida, Isao Kurosaki, Tetsuya Ohtani, Terukazu Muto, Hideo Ohtani*

Department of Surgery, Niigata University School of Medicine
*Ohtani Surgical Clinic

A 71-year-old woman with stage IV gallbladder carcinoma (GBC) which was accompanied by metastasis to the paracaval lymph nodes (Lnn. paravenosi) is presented. At the time of laparotomy it was found that the GBC had invaded the duodenum, the greater omentum and the transverse colon. The patient underwent cholecystectomy, wedge resection of the gallbladder bed, pancreatoduodenectomy and extensive dissection of regional lymph nodes. Pathological examination revealed metastasis to a paracaval node and a node around the origin of the superior mesenteric artery without metastasis to any other regional nodes. Since both the paracaval node and the node around the origin of the superior mesenteric artery are regional nodes of the duodenum, it is postulated that metastasis to these nodes originated from cancerous tissue invading the duodenum. In the case of dissection of "Lymphonodi lumbales (P.N.A.)" in radical surgery for advanced GBC, the paracaval nodes also should be dissected in some selected patients. Furthermore it is suggested that GBC invading neighboring organs i.e. the duodenum, the colon etc., might metastasize to the regional lymph nodes of the involved organs. In case radical surgery is carried out for GBC with involvement of neighboring organs, surgeons should consider the possibility of metastasis to the regional nodes of the involved organs.

Key words
gallbladder neoplasms, lymph node metastasis, radical surgery for gallbladder carcinoma

Reprint requests
Yoshio Shirai Department of Surgery, Niigata University School of Medicine
Asahimachi-dori 1, Niigata, 951 JAPAN

Accepted
November 20, 1991

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