Pathologic analysis of lymph node involvement in carcinoma of head of pancreas

Objective To investigate the pattern of lymph node involvement in carcinoma of head of pancreas in order to determine the applicability of extended pancreaticoduodenectomy. Methods Lymph nodes obtained from the extended pancreaticoduodenectomy were grouped(No.1-18) according to the Japanese Pancreas Society(JPS) General Rules for the Study of Pancreas Cancer.The frequency of each involved lymph node group was calculated,including 3 cases of liver metastases.The correlations between the lymph node involvement and the tumor differentiation,tumor size and liver metastases were investigated.Results Eighty-eight of 128 cases underwent extended pancreaticoduodenectomy had lymph node involved.The 3 most frequently involved lymph node groups were No.13,14 and 17.Fourteen of 15 cases with group lymph node metastasis of group 16 involved had lymph node metastasis of group 13,14 or 17,and the left one case had lymph node metastasis of group 16 alone.The frequency was inverse correlated with tumor differentiation,and there was no statistical correlations between lymph node involvement and tumor size or liver metastases. Conclusions The extensive lymph node involvement and earliest distant metastases leads to the high malignancy of pancreatic carcinoma.Only the patients without distant metastasis could benefit from the pancreaticoduodenectomy with extended resection of involved lymph nodes.