title: Gross appearance of the ampullary tumor predicts lymph node metastasis and outcome.
abstract: OBJECTIVE
  Patterns of lymph node involvement in carcinoma of the papilla of Vater (CPV) have not been studied in detail to date, and factors associated with lymphatic metastases and surgical outcome of this disease remain to be determined.
  
  
  METHODS
  Lymph node involvement and surgical outcome of 51 CPV patients were evaluated by extended lymphadenectomy specimens.
  
  
  RESULTS
  Lymph nodes with high metastatic potential were posterosuperior pancreaticoduodenal nodes (group 13a, 18%), posterior-inferior pancreaticoduodenal nodes (group 13b, 22%), and nodes around the superior mesenteric artery (group 14, 18%). Gross appearance of the primary tumor and depth of tumor invasion correlated with lymph node involvement (p < 0.05, respectively). A correlation with positivity was also found in groups 13 and 14. Disease-specific survival correlated with the gross appearance of the primary tumor and nodal involvement. However, there was no relationship between survival and the level of nodal involvement. Multivariate analysis indicated that the gross appearance of the tumor was the only significant independent predictor of a poor outcome.
  
  
  CONCLUSIONS
  Gross appearance of the tumor is the most important prognosticator of lymph node metastases in CPV. Nodal dissection around the superior mesenteric artery may improve survival except in patients without invasion of the sphincter of Oddi. Pylorus-preserving pancreaticoduodenectomy is the treatment of choice.
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. masatok @ staff.kanazawa-u.ac.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000379:methods*; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome