Results of Radical Lymphadenectomy in Pancreatic Carcinoma

Radical lymphadenectomy has been performed since the late 1970s, especially in the surgical departments of Japanese universities. Excellent results were reported for extended lymphadenectomy in gastric and oesophageal cancer when wide local excision was combined with systematic extended lymph node dissection. Overall 5-year survival of over 50% for the large number of patients undergoing gastric resection for cancer seems to demonstrate convincingly the value of the extended lymphadenectomy. All Oriental studies published to now are uncontrolled as are most reports from Western countries. The role of extended lymphadenectomy is therefore far from certain. On the other hand there is evidence that extended lymph node dissection in the treatment of pancreatic cancer might be of benefit to patients with small stage I and II tumours (1). All available data from published studies suggest that lymph node involvement is an important prognostic factor in patients with carcinoma of the head of the pancreas. Lymph node metastases occur in as many as 50% of the cases of even the smallest pancreatic cancers now being diagnosed and resected, especially those less than 2 cm in diameter (2). Classification of the critical areas of lymph node dissection in patients with carcinoma of pancreatic head show that perigastric lymph node involvement is found at about 14%. Para-aortic lymph node involvement in these patients is about 26% (3). Studies with radioactive colloids to determine lymphatic spread from the head of the pancreas to the para-aortic lymph nodes (area 16) showed that the main lymphatic route was found to pass through the nodes of the posterior region of the head of the pancreas (area 13) and around the superior mesenteric artery (area 14).