Appraisal of Extended Lymphnode Dissection for Carcinoma of the Papilla of Vater and Distal Bile Duct

Hisafumi Kinoshita, Toshimichi Nakayama, Shuichi Fukuda, Junji Shibata, Tadashi Yoshida, Hiroyasu Imayama

Second Department of Surgery, Kurume University School of Medicine

The authors investigaged the advantages and disadvantages of extended lymph node dissection in carcinoma of the papilla of Vater and carcinoma of the distal bile duct. The subjects included 85 former cases and 55 latter cases treated from January 1965 to December 1993. In carcinoma of the papilla of Vater, lymph node metastasis occurred in 37 cases (43.5%):21.2% in No. 13_a,b, 12.9% in No. 14 and 1.2% in NO. 16. Thirty-four patients including 7 n₂, cases survived more than 5 years. Dissection of No. 14 lymph node induced intractable diarrhea in 3 patients, one of whom died as a result of a diarrhea-relatedcomplication. Three patients suffered from local recurrence at the No. 14 lymph node. In carcinoma of the distal bile duct, lymph node metastasis occurred in 25 cases (45.5%): 16.4% in No. 13_a, 16.4% in No. I2_b2, 9.1% in No. 14 and 1.8% in No. 16. Dissection of No. 14 lymph node induced intractable diarrhea in 4 patients. Local recurrence in the retroperitoneal region was found in 8 patients. The long-term survivors and the site of recurrence indicate the importance of No. 14 and No. 16 dissection. However, No. 14 dissection may involve resection of the superior mesenteric periarterial plexus, cause postoperative intractable diarrhea, and lead to malnutrition, adversely affecting the patient's quality of life. Lymph node dissection should be conducted considering the progress of carcinoma.

Key words
carcinoma of the papilla of Vater, carcinoma of the distal bile duct, extended lymph node dissection

Reprint requests
Hisafumi Kinoshita Second Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurume, 830 JAPAN

Accepted
December 7, 1994

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