The pattern of lymphatic spread in carcinoma of the distal bile duct.

From 1995 to 1996, 20 patients with carcinoma of the distal bile duct (Bi) and 16 with carcinoma of the pancreatic head (Ph) underwent pancreaticoduodenectomy or total pancreatectomy with systematic extended lymphadenectomy. Histopathological specimens were examined with special reference to nodal metastases. Pancreatic parenchymal invasion was present in 10 of 20 patients with Bi. The frequency of nodal involvement in Bi with pancreatic invasion and Ph was significantly greater than in Bi without pancreatic invasion (p<0.05 and p<0.01, respectively). Metastasis to nodes around the superior mesenteric artery or abdominal aorta in Bi with pancreatic invasion occurred more frequently than in Bi without pancreatic invasion (p<0.05), though was not different from the frequency observed in Ph. The pattern of lymphatic spread in distal bile duct carcinoma with pancreatic invasion was practically equal to the mode in carcinoma of the pancreatic head.