Lymph node involvement in carcinoma of the head of the pancreas area

Abstract

A prospective study to determine the lymph node involvement in 33 pancreatectomy specimens (regional pancreatectomy 18, total pancreatectomy 7, Whipple partial pancreatectomy 8) was undertaken. There were 22 patients with pancreas duct adenocarcinoma, 6 with ampullary carcinoma, 3 with duodenal adenocarcinoma, 1 bile duct carcinoma and 1 of undetermined site of origin. Peripancreatic lymph nodes were divided into 5 main groups with subgroups. They are 1) Superior, Superior Head, Superior Body and Gastric; 2) Inferior: Inferior Head and Inferior Body, 3) Antenor: Anterior Pancreaticoduodenal, Pyloric and Mesenteric, 4) Posterior: Posterior Pancreaticoduodenal, Common Bile Duct, and 5 ) Splenzc: lymph nodes at hilum of spleen and at the tail of pancreas. The average number of lymph nodes found in different types of surgical specimens was: regional pancreatectomy 70, total pancreatectomy 4 1, and Whipple procedure 33. The average number of lymph nodes involved with metastatic tumor in these specimens was, respectively, 5 , 3 and 1. The most common sites of metastasis were in the Superior Head and in the Posterior Pancreaticoduodenal groups. Pancreatic duct adenocarcinoma tended to metastasize to multiple lymph nodes of the Superior Head, Superior Body and Posterior Pancreaticoduodenal lymph nodes (88% of patients). Ampullary adenocarcinoma metastasized less often (33%), usually to fewer nodes and to one adjacent periampullary group. Since in 33% of patients nodal metastases of duct adenocarcinoma of the head of the pancreas were present in groups not usually removed in the Whipple procedure, it would appear that this operation is inadequate for surgical eradication of pancreas duct adenocarcinoma of the head of the pancreas.Cower 41 If survival after surgical extirpation were to be improved, it would be necessary to know the pathway of spread of the cancer. Although the

Pancreatic trypsinogen and cathepsin B in human pancreatic carcinomas and associated metastatic lesions

“…In addition, we think that the immunoreactive peptides which are synthesised by carcinoma cells may not be present in the form of zymogen granules, unlike the trypsinogen in pancreatic acinar cells. Since it has been noted that zymogen granules are not present in any duct cell-type adenocarcinomas (Cubilla & Fitzgerald, 1978), pancreatic trypsinogen in malignant cells may not be processed in the normal way.…”

Die Wertigkeit der pyloruserhaltenden partiellen Duodenopankreatektomie beim duktalen Pankreascarcinom

“…Im Gegensatz dazu kann jedoch diese Technik zu einer verla È ngerten Magenentleerungszeit und damit einem la È ngeren Krankenhausaufenthalt bei diesen Patienten fu È hren. Noch wichtiger jedoch ist, daû in verschiedenen Publikationen angezweifelt wird, ob die PPPD, bei bo È sartigen Erkrankungen angewandt, ausreichend radikal insbesondere im Bereich des erhaltenen Duodenums sei [3,5,7,8,16,18].…”

Eingeschr�nkte chirurgische Radikalit�t beim okkulten Karzinom der Papilla Vateri

“…hinteren pancreatikoduodenalen Lymphknoten [2,3,5,9,14]. So zeigte sich in einer Studie, dab bei periampull/iren Karzinomen im Stadium pT~ unabh/ingig vom Differenzierungsgrad und der genauen Lokalisation des Karzinoms von 15 u~,tersuchten Lymphknotengruppen nut eine befallen war, das entspricht 6,7% [2,3]. Damit liegt das Risiko der prognostisch relevanten Metastasierung in der Gr6genordnung der Letalit/it der radikaleren partiellen Duodenopankreatektomie.…”