Detailed analysis of extra-pancreatic nerve plexus invasion in pancreatic body carcinoma analyzed by 50 consecutive series of distal pancreatectomy with en-bloc celiac axis resection.
OBJECTIVE
Advanced pancreatic body carcinoma frequently accompany extra-pancreatic nerve plexus (PL) invasion, one of the poor indicator of patient prognosis. The present study aimed to reveal the progress of the PL invasion from cancer of the pancreas body toward the root of the celiac artery (CA) and superior mesenteric artery (SMA) followed by investigation of the relevance of diagnostic accuracy.


METHODS
Resected specimens from 50 consecutive patients who underwent distal pancreatectomy with en bloc celiac axis resection (DP-CAR) were pathologically analyzed for the direction of PL invasion. Diagnostic accuracy on CT imaging were also investigated.


RESULTS
Thirty seven of the 50 patients (74%) were positive for PL invasion around the CHA, SPA, CA and SMA. In terms of the diagnostic accuracy, positive predictive values for the PL invasion were 35%, 36%, 43% and 81% for the SPA, CHA, CA and SMA, respectively. Among 21 patients and 23 patients with PL invasion around CHA and SPA, 13 and 6 patients also accompanied PL invasion around CA, respectively.


CONCLUSIONS
Carcinoma of the pancreatic body is found to frequently accompany PL invasion around CA. Under the limitation of low diagnostic accuracy, DP-CAR might be feasible operation that increases the possibility of R0 resection.
Takahiro
T
Tsuchikawa
Satoshi
S
Hirano
Toru
T
Nakamura
Keisuke
K
Okamura
Eiji
E
Tamoto
Soichi
S
Murakami
Yo
Y
Kurashima
Yuma
Y
Ebihara
Toshiaki
T
Shichinohe
D000368:Aged; D000369:Aged, 80 and over; D017763:Autonomic Denervation; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002445:Celiac Artery / Q000473:pathology / Q000601:surgery; D002447:Celiac Plexus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies