Neural Invasion and Lymph Node Metastasis in the Head of the Pancreas Carcinoma

Masato Kayahara, Takukazu Nagakawa, Keiichi Ueno, Tetsuo Ohta, Hironobu Kobayashi, Naotaka Kadoya, Kazuhiro Mori, Tatsuo Nakano, Itsuo Miyazaki

The Second Department of Surgery, Kanazawa University, School of Medicine

Clinicopathological studies of 44 ductal carcinomas of the head of the pancreas revealed 39 cases of retroperitoneal invasion (rpe) and 40 cases of perineural invasion in the pancreas. In the 39 rpe cases, perineural invasion in the plexus was observed in 27 cases (69%). Neither perineural invasion in the pancreas nor that in the plexus bore any relationship to tumor size. There was no correlation between the degree of intrapancreatic perineural invasion and that of lymphatic invasion or lymph node involvement. However the degree of perineural invasion in the plexus had a statistically significant correlation with that of intrapancreatic perineural invasion. The cases of positive plexus invasion showed high frequency of lymph node involvement. in particular, the No. 14 lymph node. In cases of absence of involvement of No. 14 lymph node, 10 involved perineural invasion in the plexus, particularly in the second portion of the extrapancreatic plexus. These results indicate that perineural invasion is a different manner of invasion from that in lymph node metastasis. We concluded that complete dissection of the extrapancreatic plexus, including the lymph nodes and soft tissue around the pancreas is necessary in order eradicate ductal carcinoma of the pancreas.

Key words
pancreas head cancer, neural invasion of the pancreas cancer, plexus invasion of the pancreas cancer, lymph node metastasis of the pancreas cancer, radical retroperitoneal dissection of the pancreas cancer

Reprint requests
Masato Kayahara Second Department of Surgery, Kanazawa University School of Medicine
13-1 Takaramachi, Kanazawa, 920 JAPAN

Accepted
October 11, 1990

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