Differences in the clinicopathological features of pancreatic head carcinoma in dorsal and ventral pancreas: A single institution retrospective review

Abstract

The embryonic development of the pancreas originates from dorsal and ventral anlagen, and the pancreatic cancer arising from dorsal or ventral pancreas may have different clinical pathology features. This study aims to explore whether there are differences in clinicopathological features and prognosis of pancreatic head carcinoma arising from dorsal or ventral pancreas.Between January 2014 and February 2018, 101 patients with resectable pancreatic head cancer who underwent pancreaticoduodenectomy in our institution were retrospectively reviewed. The patients were assigned into 2 groups according to tumor location on preoperative imaging materials (computed tomography/magnetic resonance imaging [CT/MRI]), and the clinicopathological features and prognosis were retrospectively analyzed in view of the embryonic development of the pancreas.Among these patients with pancreatic head cancer, 42 patients had tumors arising from dorsal pancreas (D group) and 59 patients had tumors arising from ventral pancreas (V group). The frequency of lymph node (LN) metastasis around the common hepatic artery (CHA) and hepatoduodenal ligament lymph nodes in the D group was higher than that in the V group (45.2% vs 10.2%, P = .001). And the rate of LN metastasis in the superior mesenteric artery (SMA) region in the V group is higher than that in the D group (32.2% vs 4.8%, P = .002). The D group was more likely to invade the common bile duct (78.6% vs 59.3%, P = .042) and duodenum (71.4% vs 44.1%, P = .006) than the V group. In addition, the survival outcome of V group was better than D group (median overall survival [OS], 15.37 months vs 10.53 months, P = .048, median DFS 9.73 months vs 5.93 months, P = .046).The clinicopathological features of pancreatic head carcinoma arising from dorsal or ventral pancreas are different, and the pancreatic head carcinoma arising from ventral pancreas has a better survival outcome.

Figure 1

Embryonic development of pancreas. The ventral pancreatic bud rotates to the dorsal side and fuses with the dorsal pancreatic bud to form a single pancreas.

Figure 2

The flowchart of this study.

Figure 3

A, Photograph of a resected specimen immunohistochemically stained for PP. The ventral pancreas was clearly stained, but the dorsal pancreas was not. a, CT scan image corresponding to A. The head of the pancreas was divided into the ventral and the dorsal pancreas by the line linking the PV (SMV) and the anterior edge of the intrapancreatic bile duct. Green dotted line on the photograph and the CT scan image indicates the boundary line between the dorsal and the ventral pancreas.^[14] CBD = common bile duct, GDA = gastroduodenal artery, SMA = superior mesenteric artery, SMV = superior mesenteric vein, WD = Wirsung duct.

Figure 4

The CT scan image of pancreatic head cancer arising from dorsal pancreas. The mainly tumor body located in the dorsal pancreas. CBD = common bile duct, PV = portal vein, SMV = superior mesenteric vein.

Figure 5

The CT scan image of pancreatic head cancer arising from ventral pancreas. The mainly tumor body located in the ventral pancreas. CBD = common bile duct, PV = portal vein, SMV = superior mesenteric vein.

Figure 6

Comparison of survival outcome between dorsal and ventral pancreatic head cancer. (A): for overall survival (OS); (B): for disease-free survival (DFS).