Neural invasion in pancreatic carcinoma

Abstract

Background: Neural invasion is a special metastatic route in pancreatic cancer and responsible for the high recurrence in curatively resected cases.

Objective: To summarize the characteristics and mechanisms of neural invasion in pancreatic carcinoma for the better treatment of this disease.

Data sources: The international literatures were reviewed about the definition, incidence and mechanisms of neural invasion and its clinicopathology, diagnosis and treatment.

Data synthesis: Neural invasion is defined when the medial perineurium is involved by cancer cells, accounting for 45%-100% of all cases. It can be divided into different kinds or stages according to its locations and the number of nerve fascicles involved. Invasion along vascularity, lymphatic vessels, perineural space and neurotropism is considered as its primary mechanisms. No clinicopathologic factors are correlated with neural invasion. Intravascular ultrasound, CT scan and immunostaining K-ras gene analysis can be used to diagnose neural invasion pre-, intra- or postoperatively.

Conclusion: Neural invasion is an important prognostic factor for the recurrence of pancreatic carcinoma after pancreatectomy. Because of its high incidence, pancreatectomy with extended radical retroperitoneal dissection should be considered as a basic procedure in the treatment of pancreatic carcinoma.