title: Significance of mesenteric lymphadenopathy after pancreaticoduodenectomy for periampullary carcinomas: evaluation with serial MDCT studies.
abstract: OBJECTIVE
  To evaluate the significance of mesenteric lymphadenopathy arising after pancreaticoduodenectomy (PD) for periampullary carcinomas.
  
  
  METHODS
  Serial multidetector CT (MDCT) studies in 44 patients after PD for periampullary carcinomas (Group A) were retrospectively reviewed, the incidence and interval changes of mesenteric lymphadenopathy were evaluated, and comparisons were made with 21 patients who underwent PD for benign diseases (Group B).
  
  
  RESULTS
  In Group A, mesenteric lymphadenopathy was seen in 31 of 44 (70.5%) patients. The short axis diameter of the largest lymph node ranged from 6.2 to 11.5mm (mean+/-S.D.: 8.6+/-1.4mm), and the short-axis-to-long-axis (S/L) ratio ranged from 0.46 to 0.99 (mean+/-S.D.: 0.69+/-0.12). Six of the 31 (19.4%) mesenteric lymphadenopathy cases showed interval increases in size on follow-up studies, and three cases showed new development of mesenteric lymphadenopathy: all of these nine cases had concurrent recurrence in the mesenteric root. In Group B, 11 (52.4%) had mesenteric lymphadenopathy. The short axis diameter of the largest lymph node ranged from 5.6 to 10.9mm (mean+/-S.D.: 8.0+/-1.9mm) and the S/L ratio ranged from 0.48 to 0.93 (mean+/-S.D.: 0.67+/-0.12). Differences in the incidence, short axis diameter and S/L ratio were not significant between Groups A and B (p=0.154, 0.271 and 0.654, respectively).
  
  
  CONCLUSIONS
  Mesenetric lymphadenopathy after PD less likely reflects recurrence. Lymph node metastasis may be suggested only when coexisting recurrent mass is found in the proximal mesenteric root.
authors.affiliation: Department of Clinical Radiology, Anatomic Pathology, and Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Ishigamikousei@aol.com
authors.forename: Kousei
authors.initials: K
authors.lastname: Ishigami
authors.forename: Kengo
authors.initials: K
authors.lastname: Yoshimitsu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Irie
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tajima
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Asayama
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hirakawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kakihara
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Shioyama
authors.forename: Yunosuke
authors.initials: Y
authors.lastname: Nishihara
authors.forename: Koji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging*; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010532:Peritoneal Diseases / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods