Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, Mori K, Nakano T, Takeda T, Konishi I, Miyazaki I
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Int J Pancreatol. 1993 Feb;13(1):15-22. doi: 10.1007/BF02795195.
To clarify the pattern of lymph node metastasis in carcinoma of the pancreas, lymph node involvement was examined in forty-two patients who underwent extensive nodal dissections, including the paraaortic lymph nodes. The correlation between the spread of the tumor and lymph node involvement was evaluated: The most common site of involved lymph nodes was the retropancreatic region. The prevalence of nodal metastases was 78.6%. Metastases to the paraaortic region were present in seven patients, among whom metastases in the paraaortic region were most common in the median region from the celiac artery to the inferior mesenteric artery and in the space between the aorta and the vena cava. The risk of lymph node metastases tended to increase with tumor size, except in the paraaortic region, where the correlation between the frequency of metastasis and tumor size was poor. The probability of lymph node metastases increased with the degree of lymphatic invasion (ly) and the growth pattern of the tumor (INF) and was high in patients with invasion into the retropancreatic tissue and in tumors with scirrhous histology. These results indicate that even in small cancers, lymph nodes of the paraaortic region frequently harbor metastases and should be dissected en block during radical resections of pancreatic cancer.
为明确胰腺癌的淋巴结转移模式，对42例行广泛淋巴结清扫术（包括腹主动脉旁淋巴结清扫）的患者的淋巴结受累情况进行了检查。评估了肿瘤扩散与淋巴结受累之间的相关性：受累淋巴结最常见的部位是胰后区域。淋巴结转移发生率为78.6%。7例患者出现腹主动脉旁区域转移，其中腹主动脉旁区域转移在从腹腔动脉至肠系膜下动脉的中位区域以及主动脉与腔静脉之间的间隙最为常见。除腹主动脉旁区域外，淋巴结转移风险往往随肿瘤大小增加而升高，在该区域转移频率与肿瘤大小之间的相关性较差。淋巴结转移概率随淋巴管侵犯程度（ly）和肿瘤生长方式（INF）增加而升高，在侵犯胰后组织的患者以及组织学为硬癌的肿瘤中转移概率较高。这些结果表明，即使是小癌，腹主动脉旁区域的淋巴结也常发生转移，在胰腺癌根治性切除术中应整块切除。
