Embryologic bases of extended radical resection in pancreatic cancer

Objective: To analyze whether an embryologic "rationale" exists to the clinical and anatomicopathological data that suggest the execution of extended resections in patients with pancreatic cancer. Methods: Reconstruction of serial histological sections of 18 human embryos and fetuses regarding the pancreatic region; anatomical microdissections of two 9-month fetuses. Results: The ventral and dorsal pancreatic buds can be identified until the eighth week of development. A close developmental relationship between the dorsal pancreas and the lymphatic and nervous structures in the dorsal mesogastrium is observed. Other lymphatic stations are exclusively related to the ventral pancreas. The posterior fusion of the dorsal mesogastrium is a late event in embryologic development. Conclusions: The complete fusion of the 2 pancreatic buds occurs later than previously reported in the literature. The close embryologic relations of these buds with the lymphatic and nervous peripancreatic structures may support the need for extended resections in patients with pancreatic cancer.