Lymphatic flow in carcinoma of the head of the pancreas

Abstract

The lymphatic pathway from the head of the pancreas to the para‐aortic lymph nodes was examined on the basis of the frequency of lymph node involvements. Forty‐four patients were examined. All patients had extended radical operations. Thirty‐one of 44 (70.5%) patients had lymph node involvement. The lymph nodes that had a high metastatic rate included the following: (1) lymph nodes around the common hepatic artery (number 8 lymph node); (2) lymph nodes of the hepatoduodenal ligament (number 12 lymph node); (3) the posterior pancreaticoduodenal lymph node (number 13 lymph node); (4) lymph nodes around the superior mesenteric artery (number 14 lymph node); (5) para‐aortic lymph nodes (number 16 lymph node); and (6) the anterior pancreaticoduodenal lymph node (number 17 lymph node). Twenty‐eight of these 31 patients had disease in the posterior pancreaticoduodenal lymph node. The patterns of lymph node involvement consisted of four combinations: number 13‐number 17, number 13‐number 14, number 14‐number 16, and number 17‐number a. All of the patients with number 16 nodal involvement had number 14 lymph node metastasis. However, there was no relationship between tumor size and lymph node involvement. Based on these results, the main lymphatic pathway from the head of the pancreas to the para‐aortic lymph nodes was thought to be via the lymph nodes around the superior mesenteric artery, assuming that lymphatic flow is anterograde. In addition, this study demonstrates that it is necessary to perform an extensive lymph node dissection, including the para‐aortic lymph node, even in patients with small tumors.

Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer

“…Concerning the paraaortic lymph nodes (Group 16), pathologic reports [25,26,31,33] showed that the majority of positive lymph nodes was in the areas between the celiac artery and the inferior mesenteric artery, wherever the primary tumors were situated. Therefore, only this area was included in the contouring (red area, Figures 1 and 2).…”

Extent of lymphadenectomy to associate with pancreaticoduodenectomy in patients with pancreatic head cancer for better tumor staging

“…12a, 12b and 12c because 86.6% of the available reports on the rate of metastases to station 12 come from Authors who resect Nos. 12a, 12b, 12c, 12h and 12p [14,31,32,56,62,64,66,67]. Removing 12h and 12p is best avoided because it carries the risk of the common bile duct stump being inadequately vascularized.…”

“…Details for lymph node stations 12 and 14 (drawn from papers not included in the above table because they report on partly overlapping case series): station 12a: 0%, 12b:19%, 12c: 0%; 12d: 2.4%; station 14a: 19%, 14b: 26.2%, 14c: 7.1%, 14d:14.3% -from Nagakawa[67] station 14a: 18.2%, 14b: 20.5%, 14c: 6.8%; 14d: 13.6% -from Kayahara[66]. * Stations 7 and 10 were not included in the table due to the very low incidence of metastasis.Data in the National Pancreatic Cancer Registry Committee of the Japanese Pancreatic Society 1981-1990. à Calculated on only 82 reported patients.…”

Lysophosphatidic Acid (LPA) in Malignant Ascites Stimulates Motility of Human Pancreatic Cancer Cells through LPA1

“…Pancreatic cancer is a highly metastatic cancer characterized by widespread intraperitoneal dissemination and ascites formation, which frequently occur even after curative resection and constitute the major cause of death in pancreatic cancer patients (1,2). Therefore, the suppression of dissemination is an important issue in the treatment of pancreatic cancer.…”