Neural invasion and nodal involvement in distal bile duct cancer

Nodal status and neural plexus invasion are important prognostic factors in pancreaticobiliary cancer. The relationship between neural invasion and nodal involvement is evaluated, and its significance for therapy discussed. During the last 20 years, 29 patients with distal bile duct cancer underwent pancreaticoduodenectomy at our institute. An accurate evaluation of the relationship between nodal involvement and plexus invasion was done by histological examination. Twenty of the 29 patients had nodal involvement (68.9%) including 11 patients (37.9%) with nodal involvement of the third group of lymph node (n3). None of these 11 patients had tumors confined to the bile duct wall (panc0 disease). Eight patients (27.6%) had plexus invasion. None of these patients had panc0 disease. The most frequent site of extrapancreatic plexus invasion was the first portion of the plexus pancreaticus capitalis. Nodal dissection around the superior mesenteric artery, and plexus dissection in the hepatoduodenal ligament, around the hepatic artery, and at the first portion of plexus pancreaticus capitalis is necessary in the treatment of distal bile duct cancer, except in patients with no evidence of pancreatic invasion.