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Published in: World Journal of Surgery 6/2006

01-06-2006

Clinical Significance of Lymph Node Micrometastasis in Ampullary Carcinoma

Authors: Eiko Sakata, MD, Yoshio Shirai, MD, PhD, Naoyuki Yokoyama, MD, PhD, Toshifumi Wakai, MD, PhD, Jun Sakata, MD, PhD, Katsuyoshi Hatakeyama, MD, PhD, FACS

Published in: World Journal of Surgery | Issue 6/2006

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Abstract

Background

This study aimed to clarify the clinical significance of lymph node micrometastasis in ampullary carcinoma.

Materials and Methods

Pancreaticoduodenectomy with regional lymphadenectomy was performed for 50 consecutive patients with ampullary carcinoma. A total of 1,283 regional lymph nodes (median, 25 per patient) were examined histologically for metastases. Overt metastasis was defined as metastasis detected during routine histologic examination with hematoxylin and eosin. Micrometastasis was defined as metastasis first detected by immunohistochemistry with an antibody against cytokeratins 7 and 8. The median follow-up period was 119 months after resection.

Results

Overt metastasis was positive in 90 lymph nodes from 27 patients. Micrometastasis was positive in 33 lymph nodes from 12 patients, all of whom also had overt nodal metastases. Patients with nodal micrometastasis had a larger number of lymph nodes with overt metastasis (median, 3.5) than those without (median, 0; P < 0.001). Overt metastasis to distant nodes (superior mesenteric nodes, para-aortic nodes) was more frequent (P = 0.001 and P = 0.038, respectively) in patients with nodal micrometastasis. Nodal micrometastasis was found to be a strong independent prognostic factor on univariate (P < 0.0001) and multivariate (relative risk, 5.085; P = 0.007) analyses. From among the 27 patients with overt nodal metastasis, the outcome after resection was significantly worse in the patients with nodal micrometastasis (median survival time of 11 months) than in those without (median survival time of 63 months; P = 0.0009).

Conclusions

Immunohistochemically detected lymph node micrometastasis indicates intensive lymphatic spread, and thus adversely affects the survival of patients with ampullary carcinoma.
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Metadata
Title
Clinical Significance of Lymph Node Micrometastasis in Ampullary Carcinoma
Authors
Eiko Sakata, MD
Yoshio Shirai, MD, PhD
Naoyuki Yokoyama, MD, PhD
Toshifumi Wakai, MD, PhD
Jun Sakata, MD, PhD
Katsuyoshi Hatakeyama, MD, PhD, FACS
Publication date
01-06-2006
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 6/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-7985-8

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