Lymph Node Dissection in Radical Resection for Carcinoma of the Head of the Pancreas and Periampullary Region

Resected specimens from 41 cases of carcinoma of the head ofthe pancreas or the periampullary region and autopsy specimensfrom 16 patients with recurrence were examined for lymph nodemetastasis. Evidence demonstrating the need for dissection andremoval of specific lymph node groups in pancreatoduodenectomyor total pancreatectomy was discussed. These include the commonhepatic and celiac groups, the superior mesenteric group, thejejunal group located in the mesentery of the proximal portionof the jejunum, and the retropancreatic group located behindthe uncinate process. Metastasis to these groups was found evenin cases where the carcinoma was considered small. In carcinomaof the head of the pancreas, metastasis to the peripancreaticlymph nodes was seen more widely. Therefore, total pancreatectomywith lymph node dissection is desirable for this disease.