Patterns of lymph node metastasis in carcinoma of the ampulla of vater

Background/Aims: Identification of lymph node metastasis may guide surgical therapy. The aim of this study was to clarify the lymphatic spread in ampu llary carcinoma in relation to local tumor extent (pT category in the pTNM classification). Methodology: The distribution and number of lymph node metastases were hist ologically examined in 35 patients with ampullary carcinoma. Results: Lymph node metastases were present in 10 of 15 patients (67%) with pT2 tumor and in 10 of 11 (91%) with pT3 tumor. Nodal involvement was not identified in 9 patients with pT1 tumor. The incidence of node-positive pat ients was higher in pT2 and pT3 tumors than in pT1 tumors (P<0.01). The tot al number of positive nodes per node-positive patient was greater in pT3 tu mors than in pT2 tumors (mean 3.50 vs. 1.30, P<0.001). All node-positive pa tients had metastasis to the posterior pancreaticoduodenal node. The number of positive nodes per node-positive patient in both the posterior pancreat icoduodenal and the superior mesenteric region was greater in pT3 tumors th an in pT2 tumors (P<0.01 and P<0.05). Conclusions: With increasing pT category in ampullary carcinoma, lymphatic spl cad extended from the posterior pancreaticoduodenal region to the super ior mesenteric nodes.