LYMPH-NODE METASTASIS IN CARCINOMA OF THE BODY AND TAIL OF THE PANCREAS

Background There have been no precise reports concerning lymph node me tastatic involvement in carcinoma of the body and tail of the pancreas . Methods Histopathological examination of lymph node involvement in 3 0 specimens obtained from patients who underwent pancreatic resection and wide dissection of lymph nodes, including paraaortic lymph nodes, for carcinoma of the body and tail of the pancreas was performed. Resu lts Fourteen of 30 patients had lymph node involvement. The highest in cidence of lymph node involvement was around the splenic artery (five of 30 patients), aorta (four of 30) and coeliac trunk (four of 30). No significant difference in survival rate between the lymph node-negati ve group and the lymph node-positive group was observed. but all patie nts in the positive group died within 2 years after surgery, and four patients with para aortic lymph node involvement died from recurrence within 10 months after surgery. Survival rates were significantly wors e in patients with histopathological extrapancreatic nerve plexus inva sion, retropancreatic tissue invasion, tumour diameter more than 4 cm, histological portal system vein wall invasion and carcinoma invasion of the surgical margins. Conclusion Although aggressive extended surge ry including para-aortic node dissection has been performed, the posto perative survival rate is still low in patients with carcinoma of the body and tail of the pancreas. The high incidence of liver metastasis after surgery is a prime cause of the poor outcome, and effective ther apy for postoperative liver recurrence requires evaluation.