Extensive Dissection of Lymph Nodes and Nerve Plexus for Carcinoma of the Pancreatic Head Region

Akimasa Nakao, Akio Harada, Toshiaki Nonami, Tetsuya Kaneko, Shin Takeda, Soichiro Inoue, Jiro Hosono, Shuji Nomoto, Hitoshi Inagaki, Hiroshi Takagi

Department of Surgery II, Nagoya University School of Medicine

Lymph node metastasis and extrapancreatic nerve plexus invasion of carcinoma of the pancreatic head region was histopathologically studied. Lymph node metastasis was observed in 70% of duct cell carcinomas of the pancreatic head (n=101), 39% of. common bile duct carcinomas (n=23) and 43% of papilla Vater carcinomas (n=28), respectively. Perigastric lymphb node metastasis was observed in 12% of pancreatic head carcinomas and was restricted to the subpyloric region (N. 6), with 0% in common bile duct carcinomas and 4% in papilla Vater carcinomas. Lymph node metastasis around the superior mesenteric artery (SMA) (No. 14) and para-aorta (No. 16) was observed in 23% and 25% in pancreatic head carcinoma, 9% and 9% in common bile duct carcinoma, and 0% in papilla Vater carcinoma, respectively. Neural invasion was observed in 88% of pancreatic head carcinoma, 83% of common bile duct carcinoma and 14% of papilla Vater carcinoma. Extrapancreatic nerve plexus invasion was noted in 75% of pancreatic head carcinoma with intrapancreatic neural invasion. A significant relationship was observed (p<0.001) between prognosis and extrapancreatic nerve plexus invasion, but not between prognosis and lymph node metastasis in pancreatic head carcinoma. Wide dissection of the paraaortic lymph node caused massive ascites leakage after surgery, and complete dissection of the nerve plexus around the SMA caused severe diarrhea. Postoperative nutritional support is necessary for patients with extensive surgery.

Key words
cancer of pancreatic head region, lymph node metastasis, neural invasion

Reprint requests
Akimasa Nakao Department of Surgery II, Nagoya University School of Medicine
65 Tsurumaichou, Showaku, Nagoya, 466 JAPAN

Accepted
December 7, 1994

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