Patterns of lymph node metastasis in carcinoma of the ampulla of Vater.

BACKGROUND/AIMS: Identification of lymph node metastasis may guide surgical therapy. The aim of this study was to clarify the lymphatic spread in ampullary carcinoma in relation to local tumor extent (pT category in the pTNM classification).

METHODOLOGY: The distribution and number of lymph node metastases were histologically examined in 35 patients with ampullary carcinoma.

RESULTS

Lymph node metastases were present in 10 of 15 patients (67%) with pT2 tumor and in 10 of 11 (91%) with pT3 tumor. Nodal involvement was not identified in 9 patients with pT1 tumor. The incidence of node-positive patients was higher in pT2 and pT3 tumors than in pT1 tumors (P < 0.01). The total number of positive nodes per node-positive patient was greater in pT3 tumors than in pT2 tumors (mean 3.50 vs. 1.30, P < 0.001). All node-positive patients had metastasis to the posterior pancreaticoduodenal node. The number of positive nodes per node-positive patient in both the posterior pancreaticoduodenal and the superior mesenteric region was greater in pT3 tumors than in pT2 tumors (P < 0.01 and P < 0.05).

CONCLUSIONS

With increasing pT category in ampullary carcinoma, lymphatic spread extended from the posterior pancreaticoduodenal region to the superior mesenteric nodes.