he mode of lymphatic spread in carcinoma of the bile duct

Background Knowing the prevalence of lymph node involvement associated with the location of the primary tumor is a prerequisite for operating with curative intent in carcinoma of the bile duct. Methods We evaluated 80 patients with carcinoma of the bile duct or cystic duct to investigate the frequency of lymph node involvement, the mode of lymphatic spread, and prognosis, according to the location of the primary tumor. Results The frequency of lymphatic spread of carcinomas in the proximal, middle, and distal bile ducts, excluding seven T1 tumors, was 48%, 67%, and 56%, respectively. With regard to the mode of lymphatic spread: (1) a metastatic path-way along the common hepatic artery predominated over that to the retropancreatic area in the proximal duct carcinoma group; (2) in the middle duct carcinoma group, metastatic lymph nodes were distributed widely, involving nodes around the superior mesenteric artery or at the para-aortic area; and (3) in the distal duct carcinoma group, metastatic nodes generally were localized around the head of the pancreas. Conclusions Understanding the mode of the lymphatic spread according to the primary tumor may be helpful for choosing the appropriate surgical approach with curative intent in bile duct carcinoma.