Status of Lymph Node Metastasis and Efficacy of Lymph Node Dissection Along the Superior Mesenteric Artery in Pancreatic Head Cancer: Clinicopathological Analysis of Patients Undergoing Pancreatoduodenectomy With Circumferential Lymph Nodes Dissection Along the Superior Mesenteric Artery

BACKGROUND: Between 2002 and 2013, we performed pancreatoduodenectomy (PD) with combined resection of the superior mesenteric artery (SMA) (PD-SMAR) to treat locally advanced pancreatic head cancer (PHC). Since 2011, we have performed PD with circumferential lymph node dissection along the SMA (PD-CLDS), in which we dissected lymph nodes all around the SMA for thorough lymph node dissection (LND) along the SMA. In this study, we examined the status of lymph node metastasis and the efficacy of LND along the SMA. METHODS: In the first study, 22 patients with PHC who underwent PD-SMAR were enrolled. We examined the location of lymph nodes along the SMA and the incidence of metastasis. In the second study, we examined the incidence of metastasis at each lymph node station and evaluated the efficacy of LND along the SMA with 103 patients who underwent PD-CLDS. RESULTS: Lymph nodes along the SMA were classified into five basins using PD-SMAR specimens. Lymph nodes along the SMA were the most frequent station of metastasis, which showed the highest efficacy of LND in PD-CLDS. CONCLUSIONS: Lymph nodes along the SMA are a frequent site of metastasis and LND along the SMA demonstrates high efficacy among the regional lymph nodes in PHC.