Indication of Pylorus-Preserving Pancreatoduodenectomy for Lower Bile Duct Carcinoma -A Clinicopathological Study-

Katsuhiko Uesaka, Yuji Nimura, Naokazu Hayakawa, Junichi Kamiya, Satoshi Kondo, Masato Nagino, Masahiko Miyachi

The First Department of Surgery, Nagoya University School of Medicine

We performed a clinicopathological study on 19 patients with surgically resected lower bile duct carcinoma to clarify the indication of pylorus-preserving pancreatoduodenectomy (PPPD). No patient had direct cancer extension to the stomach nor the first portion of the duodenum. Lymph node metastasis was found in 7 patients (37%). Lymph nodes Nos. 13a, b, 12b₂, 14, 17 were frequently involved, whereas lymph nodes around the distal stomach (Nos. 3 to 7) were rarely involved. In only one patient with prominent lymph node metastasis, a lymph node No. 7 was involved. Among 5 patients who had undergone PPPD, no patient had a recurrent carcinoma around the distal stomach. Carcinoma spreading superficially toward the proximal bile duct was diagnosed by percutaneous transhepatic cholangioscopy (PTCS) in 5 patients, in whom hilar bile duct resection was concomitantly performed. Our conclusions are as follows; 1) PPPD is applicable as the standard radical operation for lower bile duct carcinoma. 2) PTCS, which gives a free resection margin, is indispensable for detecting the association of superficially spreading carcinoma.

Key words
lower bile duct carcinoma, pylorus-preserving pancreatoduodenectomy, superficially spreading carcinoma

Reprint requests
Katsuhiko Uesaka Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
1-1 Kanokoden, Chikusaku, Nagoya, 466 JAPAN

Accepted
January 13, 1993

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