Para-aortic lymph node metastasis in carcinoma of the distal bile duct

BACKGROUND/AIMS: Lymph node dissection plays an important role in radical s urgery for pancreaticoduodenal carcinomas. The aim of this study was to ide ntify the critical areas of lymph node dissection in carcinoma of the dista l bile duct. METHODOLOGY: Between January 1995 and December 1996, 20 consecutive patient s with distal bile duct cancer underwent pancreaticoduodenectomy with exten ded lymph node dissection (including the para-aortic nodes). Histopathologi c findings were examined with special reference to lymph node metastasis. RESULTS: Histological evidence of lymph node metastasis was found in 11 pat ients (55%). The areas with frequent metastases were the posterior pancreat icoduodenal lymph nodes (35%), and the nodes around the hepatoduodenal liga ment (35%) and around the common hepatic artery (30%). Para-aortic lymph no de involvement was identified in 5 patients (25%). Most of these existed in the inter-aorticocaval space. Pancreatic parenchymal invasion was present in 10 patients. Half of the patients with pancreatic invasion had para-aort ic nodal involvement. Para-aortic lymph node metastasis was significantly a ssociated with pancreatic parenchymal invasion (p < 0.05). CONCLUSIONS: In carcinoma of the distal bile duct with pancreatic parenchym al invasion, extended lymph node dissection (including para-aortic nodes) s hould be undertaken because of the relatively high incidence of metastasis.