LYMPHATIC FLOW AND NEURAL PLEXUS INVASION ASSOCIATED WITH CARCINOMA OF THE BODY AND TAIL OF THE PANCREAS

BACKGROUND. Lymph node status and neural plexus invasion are the most important prognostic factors that may be amenable to surgery for carci noma of the body and tail of the pancreas. The pattern of lymphatic sp read and neural plexus invasion were evaluated by analysis of various clinicopathologic factors. METHODS. Twenty patients with carcinoma of the body and tail of the pancreas underwent pancreatectomy with system ic regional lymph node dissection at Kanazawa University Hospital. A p recise evaluation of their lymph node involvement and neural plexus in vasion was determined. RESULTS. Sixteen of 20 patients (80%) had lymph node involvement. The lymph nodes with a high metastatic rate were th ose along the splenic artery (50%), the inferior body lymph nodes (35% ), the lymph nodes around the common hepatic artery (25%), and the par aaortic lymph nodes (20%). There was no relationship between tumor siz e, histologic type, and lymph node involvement. Plexus invasion was ob served in 14 patients (70%). The most frequent site was the splenic pl exus, but between 15% and 20% of the patients had celiac or superior m esenteric plexus invasion. There was no relationship between tumor siz e, histologic type, and neural plexus invasion. CONCLUSIONS. Based on these results, extended lymphadenectomy including the paraaortic lymph nodes, celiac lymph nodes, and superior mesenteric lymph nodes may im prove the prognosis for patients with carcinoma of the body and tail o f the pancreas. Extrapancreatic neural plexus dissection, especially o f the celiac plexus and superior mesenteric plexus, also is necessary. (C) 1996 American Cancer Society.