Kobayashi H
Department of Surgery II, School of Medicine, Kanazawa University, Japan.
Nihon Geka Gakkai Zasshi. 1991 Aug;92(8):986-96.
In order to investigate lymphatic spread from the head of the pancreas to the para-aortic lymph nodes (No. 16 area), lymphatic metastases were reviewed in 42 cases of carcinoma of the head of the pancreas, and then activated carbon particles and 111In colloid were injected in 10 cases and 7 cases of pancreatoduodenal cancer, respectively. The main route from the head of the pancreas to No. 16 area was a lymphatic pathway through the lymph nodes in the posterior part of the head of the pancreas (No. 13), around the superior mesenteric artery (No. 14) and No. 16. The lymphatic metastases in No. 16 area were mainly seen in the area of 16b2. The carbon or 111In colloid also flowed to nearly the same lymph nodes of No. 16 area. The direction of the extent of those substances was especially toward the dorsal side of the level of the renal artery rather than from the rostral to the caudal. These results indicate that lymph nodes of No. 16 area should be dissected en bloc to the dorsal side of the level of the renal artery rather than from the rostral to the caudal in order to improve the radicality of the operation for pancreatic cancer.
