Percutaneous transhepatic lymphography method to image and treat intra-abdominal lymph node metastasis in patients with unresectable hepatobiliary pancreatic cancer

Background. There have been no effective treatments for intra-abdominal lymph node metastasis. One of the main reasons is that we cannot deliver chemotherapeutic agents directly. We evaluated percutaneous transhepatic lymphography (PTL) as a drug delivery system. Methods. PTL was performed 16 times in 13 patients. PTL was performed by puncture of the intrahepatic periportal area. Immediately after injection of contrast medium, lymphatic flow through the hepatoduodenal ligament to the intra-abdominal lymph nodes was visualized. The chemotherapeutic agent was delivered to the metastatic intra-abdominal lymph nodes by this route. Results. In 10 of 13 patients, intrahepatic and extrahebatic lymphatic vessels and lymph nodes were visualized by PTL. Computed tomography after PTL showed retention of lipiodol in the lymphatic system around the portal vein and in the enlarged metastatic lymph nodes located in the pancreatic and celiac lymph nodes. According to the Response Evaluation Criteria in Solid Tumors, there were 8 patients with progressive disease and 5 with stable disease. Conclusions. The present study showed that PTL can be used as a drug delivery system specific for intra-abdominal lymph nodes as well as for identification of the lymph tracts.