Abstract
Background. Although lymph node involvement is considered an important prognostic factor, a detailed
analysis has not been conducted in middle (Bm) and distal (Bi) bile duct cancer. Methods. The histopathology of resections taken from 59 patients with Bm and Bi disease (Bm,
33 patients; Bi, 26 patients) was examined. The prevalence of lymph node involvement
and its relationship to recurrence and prognosis were investigated. Survival rates
were investigated according to the number of metastatic lymph nodes found, the TNM
nodal stages, and the nodal stage classifications of The General Rules of the Japanese
Society of Biliary Surgery. Results. The frequency of nodal involvement in Bm and Bi was 45.5% and 30.8%, respectively.
A significant correlation existed between a patient's prognosis and his TNM nodal
stage, Japanese Society of Biliary Surgery nodal stage, and the number of metastatic
lymph nodes found (P <.0001, respectively). Among 8 sites of postoperative recurrence, metastasis occurred
most frequently in the liver (16/23). Patients with nodal involvement had a significantly
higher rate of liver metastasis (10/23) than those without it (6/36) (P =.024). Conclusions. The number of metastatic lymph nodes found in patients with Bm or Bi cancer, and
the nodal stage of their nodes, are significant prognostic indicators. Patients with
nodal involvement are at high risk for liver metastasis in Bm and Bi disease.(Surgery
2001;129:677-83.)
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References
- Experience with 647 consecutive tumors of the duodenum, ampulla, head of pancreas, and distal common bile duct.Ann Surg. 1989; 210: 544-556
- Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts.Ann Surg. 1980; 191: 23-29
- Changing trends in the management of extrahepatic cholangiocarcinoma.Br J Surg. 1993; 80: 1434-1439
- Bile duct carcinoma. Diagnosis and treatment.Ann Surg. 1985; 202: 139-144
- Operations for extrahepatic bile duct cancers: Are the results really improving?.Eur J Surg. 2000; 166: 535-539
- Extrahepatic bile duct carcinoma: a western experience with 118 consecutive patients.Hepatogastroenterology. 2000; 47: 349-354
- Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer.Ann Surg. 1999; 229: 76-83
- The mode of lymphatic spread in carcinoma of the bile duct.Am J Surg. 1996; 172: 239-243
- Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy.Surgery. 1997; 121: 244-249
- 4th edition. Manual for staging of cancer. JB Lippincott, Philadelphia1992: 93-98
- general rules for surgical and pathological studies on cancer of the biliary tract.4th edition. Kanehara, Tokyo1997
- Nonparametric estimation from incomplete observation.J Am Stat Assoc. 1958; 53: 457-462
- Carcinoma of the extrahepatic bile duct: mode of spread and its prognostic implications.Hepatogastroenterology. 1997; 44: 1256-1261
- Endosonographic TNM staging of extrahepatic bile duct cancer: comparison with pathological staging.Gastroenterology. 1991; 100: 1351-1361
- Surgical approaches for unresectable primary carcinoma of the hepatic hilus.Surg Gynecol Obstet. 1988; 66: 107-114
- Outcome of treatment for distal bile duct cancer.Br J Surg. 1996; 83: 1712-1715
- Prognostic determinants in extrahepatic bile duct cancer.Hepatogastroenterology. 1998; 45: 905-909
- Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors.Ann Surg. 1996; 224: 463-475
- Prognostic factors in bile duct carcinoma: analysis of 96 cases.Ann Surg. 1991; 194: 447-457
- Surgical management of 552 carcinomas of the extrahepatic bile ducts (gallbladder and periampullary tumor excluded): results of French Surgical Association Survey.Ann Surg. 1991; 213: 236-241
- Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma.Gut. 1996; 38: 525-527
- Prognostic significance of the number of positive lymph nodes in gastric carcinoma.Br J Surg. 1994; 81: 414-416
- Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer.Gastric Cancer. 1999; 2: 122-128
Article info
Publication history
Accepted:
January 20,
2001
Footnotes
*Supported in part by a grant in aid for scientific research from the Ministry of Education, Science and Culture (grant 08770986) of Japan, Tokyo.
**Reprint requests: Ryoko Sasaki, MD, Department of Surgery I, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
★Surgery 2001;129:677-83
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
