The Modes of Lymphnode Metastasis and Indication of Pyrolus Preserving Pancreaticoduodenectomy for Carcinoma of the Distal Bile Duct and Ampulla of Vater

Ryoko Sasaki, Senji Kanno, Masahiko Murakami, Yoshiro Hayakawa, Yutaka Shimada, Hidenobu Kawamura, Takayuki Suto, Yoshiyuki Tamasawa, Hidehiro Toyoshima, Hidetoshi Ohmori, Kazuyoshi Saito

First Department of Surgery, Iwate Medical University School of Medicine

In order to determine the indication for pylorus preserving pancreaticoduodenectomy (PPPD) and the appropriate method of lymphnode dissection, the mode of lymphnode metastasis was investigated clinicopathologically in 21 cases of carcinoma of the distal bile duct and 18 cases of ampulla of Vater. 1) The rate of lymphnode metastasis was 28.6% in carcinoma of the distal bile duct and 38.9% in carcinoma of the ampulla of Vater. 2) There were no significant relationships between tumor length, depth of invasion, histological differentiation and lymphnode metastasis. 3) The lymphnode metastases were frequently noted at No. (13) b (23.8%) and (17) b (9.5%) in carcinoma of the distal bile duct, and at No. (13) a (22.2%), (13) b (16.7%) and (8) (16.7%) in carcinoma of the ampulla of Vater. No. (16) lymphnode metastasis was observed in 5.9% of cases of carcinoma of the distal bile duct, and No. (14) in 9.1%, and No. (16) in 7.7% of cases of carcinoma of the ampulla of Vater. 4) Statistically there were no significant correlations between lymphnode metastasis and prognosis either in carcinoma of the distal bile duct or ampulla of Vater. 5) Among the 7 patients who underwent PPPD, death by cancer was observed in only one case. These results suggest that PPPD is the choice of operation in most patients with carcinoma of the distal bile duct and ampulla of Vater. It is especially important to dissect the lymphnode around the celiac trunc, supramesenteric artery and aorta.

Key words
surgery for carcinoma of the distal bile duct and ampulla of Vater, modes of lymphnode metastasis, indication of pyrolus preserving pancreaticoduodenectomy

Reprint requests
Ryoko Sasaki First Department of Surgery, Iwate Medical University School of Medicine
19-1 Uchimaru, Moroika, 020 JAPAN

Accepted
March 3, 1993

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