NEURAL INVASION AND NODAL INVOLVEMENT IN DISTAL BILE-DUCT CANCER

Nodal status and neural plexus invasion are important prognostic facto rs in pancreaticobiliary cancer. The relationship between neural invas ion and nodal involvement is evaluated, and its significance for thera py discussed. During the last 20 years, 29 patients with distal bile d uct cancer underwent pancreaticoduodenectomy at our institute. An accu rate evaluation of the relationship between nodal involvement and plex us invasion was done by histological examination. Twenty of the 29 pat ients had nodal involvement (68.9 %) including 11 patients (37.9 %) wi th nodal involvement of the third group of lymph node (n(3)). None of these 11 patients had tumors confined to the bile duct wall (panc(0) d isease). Eight patients (27.6 %) had plexus invasion. None of these pa tients had panc(0) disease. The most frequent site of extrapancreatic plexus invasion was the first portion of the plexus pancreaticus capit alis. Nodal dissection around the superior mesenteric artery, and plex us dissection in the hepatoduodenal ligament, around the hepatic arter y, and at the first portion of plexus pancreaticus capitalis is necess ary in the treatment of distal bile duct cancer, except in patients wi th no evidence of pancreatic invasion.