A CLINICAL-STUDY ON LYMPHATIC FLOW IN CARCINOMA OF THE PANCREATIC HEAD AREA - PERIPANCREATIC REGIONAL LYMPH-NODE GROUPING

A detailed evaluation of the involvement of regional lymph nodes in 33 patients with cancer in the pancreas, distal common bile duct and pap illa of Vater was undertaken with the aim of delineating the patterns of lymphatic spread of the tumor. Regional lymph nodes were involved i n 91.7 % of patients with pancreatic carcinoma, 62.5 % of those with c arcinoma of the distal common bile duct, and 58.3 % of those with carc inoma of the papilla of Vater. The neck of the pancreas appeared to be an 'entrepot'' through which cancer cells pass on their way to the ly mph nodes. Other outstanding routes of spread include a route via the nodes situated around the superior mesenteric artery, a perineural rou te passing through the pancreatic plexus, and metastasis to the nodes along the abdominal aorta. Grouping of the involved lymph nodes is dis cussed and a new grouping is proposed with reference to the literature .