Kayahara M, Nagakawa T, Futagami F, Kitagawa H, Ohta T, Miyazaki I
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Cancer. 1996 Dec 15;78(12):2485-91. doi: 10.1002/(sici)1097-0142(19961215)78:12<2485::aid-cncr6>3.0.co;2-j.
Lymph node status and neural plexus invasion are the most important prognostic factors that may be amenable to surgery for carcinoma of the body and tail of the pancreas. The pattern of lymphatic spread and neural plexus invasion were evaluated by analysis of various clinicopathologic factors.
Twenty patients with carcinoma of the body and tail of the pancreas underwent pancreatectomy with systemic regional lymph node dissection at Kanazawa University Hospital. A precise evaluation of their lymph node involvement and neural plexus invasion was determined.
Sixteen of 20 patients (80%) had lymph node involvement. The lymph nodes with a high metastatic rate were those along the splenic artery (50%), the inferior body lymph nodes (35%), the lymph nodes around the common hepatic artery (25%), and the paraaortic lymph nodes (20%). There was no relationship between tumor size, histologic type, and lymph node involvement. Plexus invasion was observed in 14 patients (70%). The most frequent site was the splenic plexus, but between 15% and 20% of the patients had celiac or superior mesenteric plexus invasion. There was no relationship between tumor size, histologic type, and neural plexus invasion.
Based on these results, extended lymphadenectomy including the paraaortic lymph nodes, celiac lymph nodes, and superior mesenteric lymph nodes may improve the prognosis for patients with carcinoma of the body and tail of the pancreas. Extrapancreatic neural plexus dissection, especially of the celiac plexus and superior mesenteric plexus, also is necessary.
淋巴结状态和神经丛侵犯是胰腺癌体尾部最重要的预后因素，而手术可能对其产生影响。通过分析各种临床病理因素来评估淋巴扩散模式和神经丛侵犯情况。
20例胰腺癌体尾部患者在金泽大学医院接受了胰腺切除术及系统性区域淋巴结清扫术。对其淋巴结受累情况和神经丛侵犯进行了精确评估。
20例患者中有16例（80%）出现淋巴结受累。转移率较高的淋巴结是脾动脉旁淋巴结（50%）、胰体下淋巴结（35%）、肝总动脉周围淋巴结（25%）和腹主动脉旁淋巴结（20%）。肿瘤大小、组织学类型与淋巴结受累之间无相关性。14例患者（70%）观察到神经丛侵犯。最常见的部位是脾神经丛，但15%至20%的患者有腹腔干或肠系膜上神经丛侵犯。肿瘤大小、组织学类型与神经丛侵犯之间无相关性。
基于这些结果，扩大淋巴结清扫范围，包括腹主动脉旁淋巴结、腹腔干淋巴结和肠系膜上淋巴结，可能改善胰腺癌体尾部患者的预后。胰腺外神经丛清扫，尤其是腹腔干神经丛和肠系膜上神经丛的清扫，也是必要的。
