1. Primary tumor

　

15

　　　Note:  Other organs consist of the adrenal gland, stomach, large intestine, spleen, renal vein, kidney, inferior 

vena cava, aorta, and others. The invaded organ name should be clearly indicated.

NOTE 2:  Carcinoma in situ includes non-invasive mucinous cystadenocarcinoma, IPMC, and high-grade 

pancreatic intraepithelial neoplasia (high-grade PanIN).

NOTE 3:  The degree of local extension of a case satisfying this condition is T1, even if the invasion beyond 

the pancreatic duct wall is over 20 mm. Microinvasive carcinoma is also classified as T1. IPMC, 
ITPN, and mucinous cystadenocarcinoma are classified as T1a, T1b, or T1c, depending on the 
size of invasion.

NOTE 4:  Invasion reaches either the bile duct (CH), duodenum (DU), serosal tissue (S), retropancreatic 

tissue (RP), portal venous system (PV), common hepatic artery (Ach), splenic artery (Asp), 
extrapancreatic nerve plexus (PL), or other organs (OO).

NOTE 5:  CA and SMA invasion should be equivalent to abutment/contact on images.

[Anatomical reconsideration of the extrapancreatic nerve plexus]
The definition and classification in the 3rd to 6th edition of the Classification of Pancreatic Cancer 
(1st to 3rd edition of the English version) used seven categories for the nerve plexus in accordance 
with the report by Yoshioka et al.

1)2)

: pancreatic head nerve plexus I, or PLph I; pancreatic head nerve 

plexus II, or PLph II; superior mesenteric nerve plexus, or PLsma; common hepatic artery nerve 
plexus, or PLcha; hepatoduodenal ligament nerve plexus, or PLhdl; splenic artery nerve plexus, or 
PLspa; and celiac plexus, or PLce.

Regarding the figures used in the 6th or earlier Japanese editions (Figs. 3a and 3b), the following 
issues have been pointed out and reconsidered by the anatomical classification committee (extrapan-

PLph I: pancreatic head nerve plexus I 

PLph II: pancreatic head nerve plexus II

PLsma: superior mesenteric nerve plexus 

PLcha: common hepatic artery nerve plexus

PLhdl: hepatoduodenal ligament nerve plexus 

PLspa: splenic artery nerve plexus

PLce: celiac plexus

Ⅱ

Duodenum

PV

PL ph

Ⅰ

Celiac ganglion

Right  kidney

Aorta

Inferior vena cava

Left  kidney

SMA

PL ph

Pancreas

Fig.

　3a　 Pancreatic nerve plexuses 

(cross-sectional diagram)

Right celiac ganglion

Duodenum

PL ph

Ⅱ

PL ph

Ⅰ

Left celiac ganglion

Uncinate process

SMA

PL ce

PL sma

Fig.

　3b　Extrapancreatic nerve plexuses

Fig.

　3　Extrapancreatic nerve plexus in the 6th Japanese edition