title: Patterns of lymphatic spread of carcinoma of the ampulla of Vater.
abstract: BACKGROUND
  The pattern of lymphatic spread of ampullary cancer is poorly documented. This pattern was clarified in order to define the rational extent of radical lymphadenectomy.
  
  
  METHODS
  Thirty-nine consecutive patients who underwent pancreaticoduodenectomy with radical lymphadenectomy were included in the study. A total of 1447 lymph nodes dissected from the resected specimens was examined to detect the presence of metastatic foci.
  
  
  RESULTS
  Twenty-one of the 39 patients had a total of 97 positive nodes. The sites of nodal involvement were the posterior pancreaticoduodenal (20 of 21 patients), inferior pancreaticoduodenal artery (IPDA; 12 of 21), anterior pancreaticoduodenal (three of 21), trunk of the superior mesenteric artery (three of 20), pericholedochal (three of 21), retroportal (two of 21), and para-aortic (three of five) regions. No metastases were found in the hepatic artery, cystic duct, perigastric, right coeliac, middle colic artery or right caval node groups.
  
  
  CONCLUSIONS
  Ampullary cancer mainly spreads to the posterior pancreaticoduodenal node group, then to the IPDA node group, and finally to the para-aortic area. The rational extent of radical lymphadenectomy should include the pancreaticoduodenal, superior mesenteric, pericholedochal, retroportal and para-aortic nodes.
authors.affiliation: Department of Surgery, Niigata University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shirai
authors.forename: T
authors.initials: T
authors.lastname: Ohtani
authors.forename: K
authors.initials: K
authors.lastname: Tsukada
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D016896:Treatment Outcome