Clinicopathologic Study of Carcinoma of the Papilla of Vater with Careful Evaluation of Lymph Node Metastases

A total of 34 cases of carcinoma of the papilla of Vater were studied by preparing 5 mm step-wise whole tissue sections from each patient in order to clarify the tumor’s extension histopathologically. Excluding postoperative deaths and noncuratively resected cases, the 5-year survival rate was 48.4%. The 5-year survival rate for the patients with lymph node metastases was significantly worse than for those without lymph node metastases (p < 0.05). Lymph node metastases were located primarily in the retropancreatic area and around the superior mesenteric artery. There was a long-term survivor who had lymph node metastases at the first and second barrier. He received complete dissection of the first and second barrier lymph nodes. We suggest that dissection of the second barrier lymph nodes, especially around the superior mesenteric aerery, is a necessary component of radical surgery for carcinoma of the papilla of Vater.