The Characteristics Of Lymph Node Metastasis And Prognostic Factors In Carcinoma Of The Papilla Of Vater

ObjectiveThe characteristics of lymph node metastasis, nodal metastasis-related factorsand prognostic factors in carcinoma of the papilla of Vater （CPV） afterpancreaticoduodenectomy （PD） were analyzed.MethodsFrom January2005to December2010,94patients with CPV underwent PD anddissection of regional lymph nodes at Eastern Hepatobiliary Surgery Hospital. Wecarefully evaluated nodal involvement in each patient to determine lymphatic flow ofCPV and analyzed clinicopathological ariables in relation to prognosis.Lymphaticmetastasis-related risk factors were further investigated.ResultsThe overall rate of nodal involvement was46.8%（44/94）. According to theUICC Staging （7th edition）, lymphatic invision in pT₁, pT₂, pT₃and pT₄were15.4%（2/13）,62.7%（32/51）,80%（8/10） and100%（2/2）, respectively. The metastatic ratesin the posterior pancreaticoduodenal lymph nodes, the mesopancreas lymph nodes,the hepatoduodenal ligament lymph nodes and the proper hepatic periartery lymphnodes were30.9%（29/94）,21.3%（20/94）,11.7%（11/94） and6.4%（6/94）,respectively. The significant prognostic factors were tumor pT stage （P<0.001）,duodenal wall infiltration （P=0.001）, liver metastasis （P=0.001）, pancreaticparenchymal invision （P=0.004）, nodal involvement （P<0.001） and each regionallymph nodes invasion （the posterior pancreaticoduodenal, P<0.001; the mesopancreas，P<0.001; the hepatoduodenal ligament, P<0.001; the proper hepatic periartery,P=0.010）. Cox regression analysis for overall survival revealed that the posterior pancreaticoduodenal nodal involvement （P<0.001）, the mesopancreas nodalinvolvement （P<0.001） and duodenal wall infiltration （P=0.019） were significantindependent prognostic risk factors. Single factor analysis showed that duodenalwall infiltration （P<0.001）, pT stage （P=0.013）, gross appearence（P=0.038） wererelated to lymph node metastasis,and duodenal wall infiltration （P<0.001） was provedto be the only independent risk factor in multi-factor logistic regression analysis.ConclusionsThe mesopancreas lymph nodes and the posterior pancreaticoduodenal lymphnodes should be regarded equally as first stop in lymphatic drainage of CPV.Therefore, we should pay much attention to these regional lymph nodes dissection,especially ensure complete resection of the uncinate process and mesopancreas.Preoperative diagnosis of the depth in duodenal wall infiltration can be used as anindicator of lymph node metastasis and prognosis.