Lymphatic Flow in Carcinoma of the Distal Bile Duct Based on a Clinicopathologic Study

Background: Nodal status is one of the most important prognostic factors for distal bile duct cancer. The pattern of lymphatic spread of distal bile duct cancer was analyzed by determining the frequency of involvement of various lymph nodes.

Materials And Methods: From 1973 to 1991, 29 patients with distal bile duct cancer underwent pancreaticoduodenectomy at Kanazawa University Hospital. A precise evaluation of their nodal involvement and the relationship among the lymph nodes was determined by histopathologic examination.

Results: Twenty of the 29 (68.9%) patients had nodal involvement. The lymph nodes with a high metastatic rate were those around the lower portion of the hepatoduodenal ligament (number 12abp2), the superior posterior pancreaticoduodenal lymph nodes (number 13a), and the superior mesenteric artery (number 14) (12abp2, 24.1%; 13a, 51.7%; 14, 34.5%). At least one para-aortic lymph node was involved with cancer in two (6.9%) patients. All of the patients except one who had one or more positive number 14 lymph nodes also had positive number 12abp2 or 13a lymph nodes.

Conclusions: Lymph nodes number 12abp2 and 13a are important in lymphatic metastasis to superior mesenteric lymph node for distal bile duct cancer. Nodal dissection around the superior mesenteric artery should be performed in all patients except those without pancreatic invasion.