title: Nerve plexus invasion in pancreatic cancer: spread patterns on histopathologic and embryological analyses.
abstract: OBJECTIVE
  Although extrapancreatic nerve plexus (PLX) invasion is an important prognostic factor in pancreatic carcinoma, the spreading patterns of carcinoma via PLX have not been carefully explored because of the complex anatomical structures around the pancreas.
  
  
  METHODS
  Fifty-eight patients underwent pancreaticoduodenectomy for carcinoma of the head of the pancreas. The patterns of PLX invasion were evaluated by careful pathological examination. The relationship between tumor location considering the embryological structure of the pancreas and the site of PLX invasion was investigated with an immunohistochemical study using pancreatic polypeptide.
  
  
  RESULTS
  Forty-six patients (79%) had PLX invasion. The typical patterns of PLX invasion were detected by pathological examination. Patients with carcinoma in ventral pancreas frequently had pancreatic head plexus 1, pancreatic head plexus 2, and superior mesenteric arterial plexus invasion. Patients with carcinoma in dorsal pancreas had invasion into common hepatic artery plexus and plexus within the hepatoduodenal ligament. A significant correlation between tumor location and the site of PLX invasion was observed.
  
  
  CONCLUSIONS
  Extrapancreatic nerve plexus invasion by carcinoma of the head of the pancreas could be divided into 2 patterns based on an embryological structure of the pancreas and the location of the tumor. These results about PLX invasion may provide important information to determine surgical strategy for carcinoma of the head of the pancreas.
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Makino
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Nakagawara
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Tajima
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohnishi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Tani
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D017615:Enteric Nervous System / Q000473:pathology* / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D008022:Ligaments / Q000473:pathology; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000196:embryology / Q000294:innervation / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy