Clinicopathologic assessment of pancreatic ductal carcinoma located at the head of the pancreas, in relation to embryonic development.
OBJECTIVE
Pancreaticoduodenectomy is performed for pancreatic head cancer that originated from the dorsal or ventral primordium. Although the extent of lymph node (LN) dissection is the same irrespective of the origin, the lymphatic continuities may differ between the 2 primordia.


METHODS
Between March 2003 and September 2010, 152 patients underwent pancreaticoduodenectomy for pancreatic cancer. One hundred six patients were assigned into 2 groups according to tumor location on preoperative computed tomography, and their clinical and pathological features were retrospectively analyzed in view of the embryonic development of the pancreas.


RESULTS
Sixty of 106 patients were classified with tumors that were derived from the dorsal pancreas (D group) and 46 from the ventral pancreas (V group). The frequency of LN involvement around the middle colic artery (LN 15) in the D group was higher than in the V group (P = 0.008). The rate of additional resection of the pancreas tended to be higher in the D group (P = 0.067).


CONCLUSIONS
The present study showed the detailed pattern of spread of pancreatic ductal carcinoma to the LNs and provided important information for determining the optimal surgical strategy.
Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yukiyasu
Y
Okamura
Tsutomu
T
Fujii
Akiyuki
A
Kanzaki
Suguru
S
Yamada
Hiroyuki
H
Sugimoto
Shuji
S
Nomoto
Shin
S
Takeda
Akimasa
A
Nakao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000196:embryology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010179:Pancreas / Q000000981:diagnostic imaging / Q000196:embryology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000196:embryology* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed