Significance of perigastric lymph node involvement in periampullary malignant tumor

AIM: To determine the perigastric lymph node involvement in periampullar tumors, in an attempt to optimize the surgical treatment of pylorus-preserving pancreatoduodenectomy. METHODS: We retrospectively investigated the frequence of lymph nodes involvement in perigastric regions. Distribution and number of involved lymph nodes were exambined from 112 patients with carcinoma of pancreas, 59 patients with distal bile duct carcinoma, and 41 patients with carcinoma of the papilla of Vater. RESULTS: The frequency of lymphatic spread of carcinoma in pancreas; distal bile duct and papilla of Vater was 18.7%, 1.9%, 2.5% respectively. With regard to the mode of lymphatic spread in perigastric region, Infrapyloric nodes of carcinoma of the head of pancreas predominated over others, in carcinomas of the distal bile duct and the papilla of Vater, the left gastric artery, and the greater curvature lymph nodes was the only sole sites, respectively. CONCLUSION: Understanding perigastric lymphatic involvement in periampullary tumors may be helpful for choosing the appropriate surgical approaches to pancreatoduodenectomy with preservation of pylorus.