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Navez J, Pezzullo M, Bouchart C, Arsenijevic T, Demetter P, Closset J, Azurmendi Senar O, Racu ML, D’Haene N, Devière J, Verset L, Bali MA, van Laethem JL. Impact of the radiological morphology of the mesopancreas on the outcome after pancreatoduodenectomy for pancreatic ductal adenocarcinoma: retrospective study. BJS Open 2024; 8:zrae134. [PMID: 39601263 PMCID: PMC11599710 DOI: 10.1093/bjsopen/zrae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/18/2024] [Accepted: 10/09/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND The most frequently invaded margins on pancreatoduodenectomy specimens for pancreatic ductal adenocarcinoma are vascular margins, particularly the superior mesenteric artery (or mesopancreatic) margin. Due to limited exploration of the radiological aspect of the mesopancreas, the aim of this study was to evaluate mesopancreatic infiltration through imaging of patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy, to correlate these findings with histopathology and evaluate their impact on survival. METHODS Data for all patients who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma from 2015 to 2021 were reviewed, including review of surgical margin histopathology and blinded review of preoperative diagnostic imaging. According to qualitative radiological assessment, the mesopancreas was characterized as having normal fat, fat stranding, or solid infiltration. Survival data were analysed using Cox regression. RESULTS A total of 149 patients were included. At baseline imaging, mesopancreatic fat stranding or solid infiltration was present in 47 patients (31.5%) and 20 patients (13.4%) respectively. Median overall survival and disease-free survival were significantly lower with mesopancreatic solid infiltration (17 and 8 months) compared with normal fat (30 and 14 months) and fat stranding (29 and 16 months) (P = 0.017 and 0.028 respectively). In multivariable analysis, pathological tumour size was an independent prognostic factor for overall survival, and tumour location in the uncinate process and pathological tumour size were independent prognostic factors for disease-free survival. CONCLUSION At diagnostic imaging, solid infiltration (but not fat stranding) of the mesopancreas is associated with a poor prognosis for pancreatic ductal adenocarcinoma patients who undergo pancreatoduodenectomy. Pathological tumour size significantly influences the prediction of overall survival, and tumour location in the uncinate process and pathological tumour size significantly influence the prediction of disease-free survival, suggesting further exploration of underlying mechanisms related to retroperitoneal tumoral invasion of vascular margins and the mesopancreas.
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Affiliation(s)
- Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Martina Pezzullo
- Department of Radiology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Christelle Bouchart
- Department of Radiotherapy, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Tatjana Arsenijevic
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pieter Demetter
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre de Morphologie Pathologique (CMP), Cerba Path, Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Oier Azurmendi Senar
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marie-Lucie Racu
- Department of Pathology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Nicky D’Haene
- Department of Pathology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Jacques Devière
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Laurine Verset
- Department of Pathology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Maria A Bali
- Department of Radiology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Jean-Luc van Laethem
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
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Kim HS, Kang MJ, Kang J, Kim K, Kim B, Kim SH, Kim SJ, Kim YI, Kim JY, Kim JS, Kim H, Kim HJ, Nahm JH, Park WS, Park E, Park JK, Park JM, Song BJ, Shin YC, Ahn KS, Woo SM, Yu JI, Yoo C, Lee K, Lee DH, Lee MA, Lee SE, Lee IJ, Lee H, Im JH, Jang KT, Jang HY, Jun SY, Chon HJ, Jung MK, Chung YE, Chong JU, Cho E, Chie EK, Choi SB, Choi SY, Choi SJ, Choi JY, Choi HJ, Hong SM, Hong JH, Hong TH, Hwang SH, Hwang IG, Park JS. Practice guidelines for managing extrahepatic biliary tract cancers. Ann Hepatobiliary Pancreat Surg 2024; 28:161-202. [PMID: 38679456 PMCID: PMC11128785 DOI: 10.14701/ahbps.23-170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 05/01/2024] Open
Abstract
Backgrounds/Aims Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.
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Affiliation(s)
- Hyung Sun Kim
- Department of Surgery, Pancreatobiliary Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Mee Joo Kang
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jingu Kang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Young Kim
- Department of Pathology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Sil Kim
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ji Hae Nahm
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Suk Park
- Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Eunkyu Park
- Division of HBP Surgery, Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Joo Kyung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Byeong Jun Song
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Keun Soo Ahn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sang Myung Woo
- Center for Liver and Pancreatobiliary Cancer, Hospital, Immuno-Oncology Branch Division of Rare and Refractory Center, Research Institute of National Cancer Center, Goyang, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Huisong Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jung Ho Im
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Young Jang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun-Young Jun
- Department of Pathology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Jae Chon
- Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Min Kyu Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong Eun Chung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Uk Chong
- Department of Surgery, National Health Insurance Services Ilsan Hospital, Goyang, Korea
| | - Eunae Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Byeol Choi
- Department of Surgery, Korea Universtiy Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seo-Yeon Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Ji Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye-Jeong Choi
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyung Hong
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Hong
- Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary’s Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin Hye Hwang
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - In Gyu Hwang
- Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University Hospital Chung-Ang University College of Medicine, Seoul, Korea
| | - Joon Seong Park
- Department of Surgery, Pancreatobiliary Clinic, Yonsei University College of Medicine, Seoul, Korea
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Si K, Wu H, Yang M, Guo Y, Zhang X, Ding C, Xue J, Han P, Li X. Utility of Dark-Blood Dual-Energy CT Images for Predicting Vascular Involvement and R0 Resection in Patients With Pancreatic Cancer. AJR Am J Roentgenol 2023; 220:838-848. [PMID: 36541594 DOI: 10.2214/ajr.22.28640] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND. Current CT criteria for assessing vascular involvement by pancreatic ductal adenocarcinoma (PDAC) use circumferential contact as an indirect indicator. Dark-blood images derived from dual-energy CT (DECT) provide high lumen-to-wall contrast and may aid assessment. OBJECTIVE. The purpose of this study was to compare the diagnostic performance of 55-keV virtual monoenergetic images (VMIs) assessed using NCCN criteria with that of dark-blood images assessed using wall-based criteria for predicting vascular involvement and surgical resection that achieves microscopically negative margins (i.e., R0 resection) in patients with PDAC who undergo contrast-enhanced DECT. METHODS. This retrospective study included 109 patients (mean age, 62.6 ± 8.8 [SD] years; 66 men, 43 women) with histologically confirmed PDAC who underwent pancreatic parenchymal and portal venous phase DECT within 4 weeks before surgery (including PDAC resection in 73 patients) between July 2020 and June 2022. Dark-blood images were derived using a two-material decomposition algorithm. Two radiologists independently reviewed 55-keV VMIs and dark-blood images in separate sessions to evaluate celiac artery, common hepatic artery, superior mesenteric artery, portal vein, and superior mesenteric vein involvement; a third radiologist resolved discrepancies. On 55-keV VMIs, vessel relationships were classified as no contact, abutment (≤ 180° contact), or encasement (> 180° contact). On dark-blood images, vessel walls were categorized as intact circumferentially, irregular, or discontinuous. Tumor resectability status was classified on the basis of vessel relationships. Surgical observation served as the reference for vascular involvement. Margin status was determined for resected tumors. RESULTS. Across the five vessels, for predicting vascular involvement, abutment or encasement on 55-keV VMIs had sensitivity of 100.0% (all vessels) and specificity of 66.2-92.9%, and an irregular or discontinuous wall on dark-blood images had sensitivity of 80.0-100.0% and specificity of 88.2-98.0%. Specificity was higher for an irregular or discontinuous wall than for abutment or encasement for all vessels (all p < .05); sensitivity was not different for any vessel (all p > .05). Resectable disease classified by dark-blood images, compared with resectable disease classified by 55-keV VMIs, showed no difference in sensitivity (89.5% vs 78.9%, p = .33) but showed higher specificity (75.9% vs 59.3%, p = .01) for predicting R0 resection. CONCLUSION. Dark-blood images showed higher diagnostic performance than 55-keV VMIs for predicting vascular involvement and R0 resection in patients with PDAC. CLINICAL IMPACT. Dark-blood images may aid decisions regarding neoadjuvant therapy and surgical planning for PDAC.
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Affiliation(s)
- KeKe Si
- Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - HeShui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Yang
- Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - YiWan Guo
- Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - XiaoHui Zhang
- Department of Clinical Science, Philips Healthcare Greater China, Shanghai, China
| | - ChengYu Ding
- Department of Clinical Science, Philips Healthcare Greater China, Shanghai, China
| | - Jun Xue
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Han
- Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xin Li
- Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Zhang T, Zhang Y, Wang J, Hou J, Liu W. Multidetector computed tomography assessment of venous invasion in hepatic alveolar echinococcosis. Abdom Radiol (NY) 2023; 48:297-305. [PMID: 36207628 PMCID: PMC9849186 DOI: 10.1007/s00261-022-03640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The objective of this study was to correlate multidetector computed tomography (MDCT) findings in hepatic alveolar echinococcosis (HAE) with intraoperative and postoperative histopathological results to identify reliable MDCT criteria for the diagnosis of HAE venous invasion. METHODS A total of 136 HAE patients who underwent CT examination were included in this study. The lesion-vessel contact angle, irregular wall, lumen stenosis and occlusion were evaluated. RESULTS A total of 614 veins were estimated. In total, 510 veins were invaded, and 104 veins were not. The invasion rate was 83.06%. In single CT findings, with a cutoff value of > 180° determined by receiver operating characteristic (ROC) curve analysis, the lesion-vessel contact angle performed the best (area under the ROC curve, AUC = 0.907, 95% confidence interval, 95% CI 0.872-0.941, p < 0.001), with a sensitivity, specificity and positive likelihood ratio (PLR) of 84.90%, 88.46%, and 7.35, respectively. Irregular wall and lumen stenosis showed the lowest diagnostic performance. Diagnostic performance was the highest when combining these criteria and signs (AUC = 0.932, 95% CI 0.905-0.960, p < 0.001). CONCLUSION The lesion-vessel contact angle > 180° had the best sensitivity and specificity in the diagnosis of HAE venous invasion, and good interobserver agreement had been noted. The diagnostic performance of the lesion-vessel contact angle > 180° had been further improved with the addition of lumen occlusion accompanied by irregular wall or lumen stenosis.
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Affiliation(s)
- Tieliang Zhang
- grid.412631.3Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Yuan Zhang
- grid.13394.3c0000 0004 1799 3993Imaging Center, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Jian Wang
- grid.412631.3Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Juan Hou
- grid.412631.3Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Wenya Liu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, Xinjiang, China.
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Tonini V, Zanni M. Pancreatic cancer in 2021: What you need to know to win. World J Gastroenterol 2021; 27:5851-5889. [PMID: 34629806 PMCID: PMC8475010 DOI: 10.3748/wjg.v27.i35.5851] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is one of the solid tumors with the worst prognosis. Five-year survival rate is less than 10%. Surgical resection is the only potentially curative treatment, but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients. Moreover, surgery is still associated with high post-operative morbidity, while other therapies still offer very disappointing results. This article reviews every aspect of pancreatic cancer, focusing on the elements that can improve prognosis. It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.
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Affiliation(s)
- Valeria Tonini
- Department of Medical Sciences and Surgery, University of Bologna- Emergency Surgery Unit, IRCCS Sant’Orsola Hospital, Bologna 40121, Italy
| | - Manuel Zanni
- University of Bologna, Emergency Surgery Unit, IRCCS Sant'Orsola Hospital, Bologna 40121, Italy
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Zhou Q, Dong G, Zhu Q, Qiu Y, Mao L, Chen J, Zhou K, Hu A, He J. Modification and comparison of CT criteria in the preoperative assessment of hepatic arterial invasion by hilar cholangiocarcinoma. Abdom Radiol (NY) 2021; 46:1922-1930. [PMID: 33159559 DOI: 10.1007/s00261-020-02849-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of three CT criteria and two signs in evaluating hepatic arterial invasion by hilar cholangiocarcinoma. METHODS In this study, we retrospectively reviewed the CT images of 85 patients with hilar cholangiocarcinoma. Modified Loyer's, Lu's, and Li's standards were used to evaluate hepatic arterial invasion by hilar cholangiocarcinoma with the reference of intraoperative findings and/or the postoperative pathological diagnosis. Arterial tortuosity and contact length were also evaluated. RESULTS Loyer's, Lu's, and Li's standards showed sensitivities of 91.7%, 90.3%, and 72.2%, specificities of 94.0%, 94.5%, and 95.6%, and accuracies of 93.3%, 93.3%, and 89.0%, respectively, in evaluating hepatic arterial invasion by hilar cholangiocarcinoma. Loyer's and Lu's standards and contact length performed better than Li's standard (P < 0.001). Arterial tortuosity performed worse than other criteria (P < 0.001). The CT criteria performed best in evaluating proper hepatic arterial invasion compared with the left and right hepatic artery. When the cut-off contact length of 6.73 mm was combined with Loyer's standard, 4 false-negative cases could be avoided. CONCLUSIONS Loyer's and Lu's standards and the contact length performed best in evaluating hepatic arterial invasion by hilar cholangiocarcinoma on preoperative CT images, particularly in assessing the proper hepatic artery. Arterial tortuosity could serve as an important supplement. The combination of the contact length and Loyer's standard could improve the diagnostic performance.
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Affiliation(s)
- Qun Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Guoqiang Dong
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Qiongjie Zhu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Yudong Qiu
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Liang Mao
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Jun Chen
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Kefeng Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
| | - Anning Hu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
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Chen F, Zhou Y, Qi X, Xia W, Zhang R, Zhang J, Gao X, Zhang L. CT texture analysis for the presurgical prediction of superior mesenteric-portal vein invasion in pancreatic ductal adenocarcinoma: comparison with CT imaging features. Clin Radiol 2021; 76:358-366. [PMID: 33581837 DOI: 10.1016/j.crad.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/08/2021] [Indexed: 12/19/2022]
Abstract
AIM To investigate the value of computed tomography (CT) texture analysis (TA) and imaging features for evaluating suspected surgical superior mesenteric-portal vein (SMPV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Fifty-four patients with PDAC in the pancreatic head or uncinate process with suspected SMPV involvement were analysed retrospectively. SMPV invasion status was identified by surgical exploration. For each patient, 396 texture features were extracted on pretreatment CT. Non-parametric tests and minimum redundancy maximum relevance were used for feature selection. A CTTA model was constructed using multivariate logistic regression, and the area under the receiver operating characteristic (AUROC) of the model was calculated. Two reviewers evaluated qualitative imaging features independently for SMPV invasion and interobserver agreement was investigated. The diagnostic performance of the imaging features and the CTTA model for SMPV invasion was compared using the McNemar test. RESULTS Of the 54 patients with PDAC, SMPV invasion was detected in 23 (42.6%). The CTTA model yielded an AUROC of 0.88 (95% confidence interval, 0.76-0.97) and achieved significantly higher specificity (0.90) than the two reviewers (0.61 and 0.65; p=0.027 and 0.043). Interobserver agreement was moderate between the two reviewers (κ = 0.517). Of the 13 cases with disagreement between the two reviewers, 11 cases were predicted accurately by the CTTA model. CONCLUSION CTTA can predict suspected SMPV invasion in PDAC and may be a beneficial addition for qualitative imaging evaluation.
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Affiliation(s)
- F Chen
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Y Zhou
- Department of Hepatobiliary Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - X Qi
- Department of Pathology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - W Xia
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - R Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - J Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - X Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - L Zhang
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
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Ahmed SA, Mourad AF, Hassan RA, Ibrahim MAE, Soliman A, Aboeleuon E, Elbadee OMA, Hetta HF, Jabir MA. Preoperative CT staging of borderline pancreatic cancer patients after neoadjuvant treatment: accuracy in the prediction of vascular invasion and resectability. Abdom Radiol (NY) 2021; 46:280-289. [PMID: 32488556 DOI: 10.1007/s00261-020-02605-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the utility of MDCT tumor-vascular interface criteria for predicting vascular invasion and resectability in borderline pancreatic cancer (BRPC) patients after neoadjuvant therapy (NAT). METHODS This prospective study included 90 patients with BRPC who finished NAT, showed no progression in preoperative CTs and underwent surgery. Two radiologists independently assessed preoperative vessel-tumor interface criteria. The area under the ROC curve (AUC) was used to evaluate the diagnostic performance for predicting vascular invasions and resectability using surgical and pathological results as the gold standard. Inter-reader agreement was assessed using the κ coefficient. RESULTS Pathologic vascular invasion was confirmed in 47 (54.7%) veins and 14 (16.3%) arteries. R0 resection was achieved in (82.6%71/86) pancreatic resection. Using criteria of circumferential interface ≥ 180 degrees with contour deformity ≥ grade 3 and/or length of tumor contact > 2 cm to predict vascular invasion, the AUCs for the two readers were 0.85-0.88 for arterial invasion and 0.92-0.87 for venous invasion. Using criteria of circumferential interface ≤ 180° with contour deformity ≤ grade 2 and/or length of tumor contact < 2 cm to predict R0 resection, the AUCs was 0.85-0.86 for the two readers. The overall inter-reader agreement was good (κ = 0.75-0.80). The κ values for venous invasion, arterial invasion and R0 resection were 0.76, 0.78, and 0.80. CONCLUSION Tumor-vessel criteria demonstrated good diagnostic performance and reproducibility in the prediction of vascular invasion after NAT in BRPC. These criteria could be helpful in the prediction of R0 resection in cases with only venous involvement.
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Affiliation(s)
| | - Amr F Mourad
- Radiodiagnosis, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
| | - Ramy A Hassan
- General Surgery, Faculty of Medicine, Alrajhy Liver Hospital, Assiut University, Asyut, Egypt
| | | | - Ahmed Soliman
- General Surgery, Faculty of Medicine, Alrajhy Liver Hospital, Assiut University, Asyut, Egypt
| | - Ebrahim Aboeleuon
- Surgical Oncology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
| | - Osama Mostafa Abd Elbadee
- Radiotherapy and Nuclear Medicine Department, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
| | - Helal F Hetta
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267-0595, USA
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Murad A Jabir
- Surgical Oncology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
- Kyoto University, Kyoto, Japan
- Case Western Reserve University, Cleveland, USA
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9
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Lapshyn H, Schulte T, Sondermann S, May K, Petrova E, Honselmann KC, Braun R, Zemskov S, Keck T, Wellner UF, Bausch D, Bolm L. Radiological prediction of portal vein infiltration in patients with pancreatic ductal adenocarcinoma. Pancreatology 2021; 21:155-162. [PMID: 33309623 DOI: 10.1016/j.pan.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy characterized by early loco-regional invasion. Portal vein resection (PVR) during pancreatoduodenectomy (PD) for PDAC is performed if tumor cell invasion to the venous wall (PVI) is suspected. The aim of this study is to evaluate radiological criteria for predicting PVR and PVI. METHODS Patients undergoing PD for PDAC were identified from a prospectively maintained database. On the basis of CT- and MRI-based imaging portal vein tumor contact (PV), stranding of the superior mesenteric artery (SMA) and any alterations of the superior mesenterico-portal vein (SMPV) were evaluated. The accuracy of PVI and PVR prediction based on the radiological parameters was calculated. RESULTS 143 patients were included in the study. 48 patients underwent PVR (34%), PVI was diagnosed in 23 patients (16%). Median overall survival was 22 months. Prediction of PVR (sensitivity 79%, negative predictive value 88%, p = 0.010) and PVI (sensitivity 95%, negative predictive value 99%, p = 0.002) was most accurate for any SMPV alterations as compared to the other radiological parameters. SMPV alterations qualified as an independent prognostic parameter (26.5 months vs. 33.5months, p = 0.034). CONCLUSION Radiological evaluation of any SMPV alterations is a simple preoperative method to accurately predict PVI. Assessing SMPV alterations may help to identify candidates for neoadjuvant therapy.
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Affiliation(s)
- Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Theresa Schulte
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Stefan Sondermann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Katharina May
- Department of Radiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Kim C Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Rüdiger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Sergii Zemskov
- Department of General Surgery, Bogomolets National Medical University, Bogomolets, 01601, Kiev, No 13, Shevchenko Av, Ukraine
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Ulrich F Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Dirk Bausch
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany; Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
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10
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Abstract
Importance In the past few decades, there has been rapid advancements in imaging technologies that have become irreplaceable in the pre-operative assessment of patients with pancreatic tumors. Modern imaging modalities, including computed tomography (CT) and endoscopic ultrasound (EUS), can provide critical information of the absence or presence of metastatic disease in pancreatic cancer, as well as details on the local extent and resectability, allowing for the selection of stage appropriate treatments and pre-operatively determined surgical approach. Objective The aim of this review is to discuss staging, resectability, and imaging for patients with pancreatic tumors. Evidence Review A literature review was performed of articles relevant to the topics of staging, resectability, and imaging of pancreatic tumors. Imaging modalities included CT, EUS, magnetic resonance imaging (MRI), positron emission tomography (PET), antibody-based and narrow band imaging. Findings CT pancreas protocol combined with EUS serve as the primary modalities in diagnosis, staging, and surgical planning in patients with pancreatic tumors. MRI is an alternative to CT with near equivalent utility in the pre-operative setting. In some circumstances, PET-CT may be a cost-effective initial study to detect distant disease. Conclusions and Relevance Current imaging technologies play a critical role in the evaluation of patients with pancreatic tumors. Advances in the past 3 decades in imaging technologies have revolutionized the process of assessment of stage and resectability in patients with pancreatic tumors. Future imaging technologies will address current limitation in the evaluation of occult metastatic disease.
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11
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The Reliability of Quantifying the Pancreatic Ductus in Predicting the Operability of Pancreatic Adenocarcinomas. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.655932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Systematic Analysis of Accuracy in Predicting Complete Oncological Resection in Pancreatic Cancer Patients-Proposal of a New Simplified Borderline Resectability Definition. Cancers (Basel) 2020; 12:cancers12040882. [PMID: 32260453 PMCID: PMC7226508 DOI: 10.3390/cancers12040882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Borderline resectability in pancreatic cancer (PDAC) is currently debated. Methods: Patients undergoing pancreatic resections for PDAC were identified from a prospectively maintained database. As new borderline criteria, the presence of any superior mesenterico-portal vein alteration (SMPV) and perivascular stranding of the superior mesenteric artery (SMA) was evaluated in preoperative imaging. The accuracy of established radiological borderline criteria as compared to the new borderline criteria in predicting R status (sensitivity/negative predictive value) and overall survival was assessed. (3) Results: 118 patients undergoing pancreatic resections for PDAC from 2013 to 2018 were identified. Forty-three (36.4%) had radiological perivascular SMA stranding and 55 (46.6%) had SMPV alterations. Interrater reliability was 90% for SMA stranding and 87% for SMPV alterations. The new borderline definition including SMPV alterations and perivascular SMA stranding was the best predictor of conventional R status (p = 0.040, sensitivity 53%, negative predictive value 81%) and Leeds/Wittekind circumferential margin status (p = 0.050, sensitivity 73%, negative predictive value 79%) as compared to established borderline resectability definition criteria. Perivascular SMA stranding qualified as an independent negative prognostic parameter (HR 3.066, 95% CI 1.078-5.716, p = 0.036). Conclusion: The radiological evaluation of any SMPV alteration and perivascular SMA stranding predicts R status and overall survival in PDAC patients, and may serve to identify potential candidates for neoadjuvant therapy.
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Toesca DA, Jeffrey RB, von Eyben R, Pollom EL, Poullos PD, Poultsides GA, Fisher GA, Visser BC, Koong AC, Chang DT. Predicting Pancreatic Cancer Resectability and Outcomes Based on an Objective Quantitative Scoring System. Pancreas 2020; 48:622-628. [PMID: 31091207 PMCID: PMC6553971 DOI: 10.1097/mpa.0000000000001314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To quantitatively assess the probability of tumor resection based on measurements of tumor contact with the major peripancreatic vessels. METHODS This is a retrospective cohort study of pancreatic cancer patients treated between January 2001 and December 2015 in a single academic comprehensive cancer center. Radiographic measurements of the circumferential degree and length of solid tumor contact with major peripancreatic vessels were obtained from diagnostic pancreatic protocol computed tomography images and tested for correlation with tumor resection and margin status. RESULTS Of 294 patients analyzed, 113 (38%) were resected, with 71 (63%) with negative margins. Based on the individual measurements of vascular involvement, a resectability scoring system (RSS) was created. The RSS correlated strongly with resection (P < 0.0001) and R0 resection (P < 0.0001) probabilities. Moreover, the RSS correlated with overall survival (P < 0.0001) and metastasis-free survival (P < 0.0001), being able to substratify resectable (P = 0.022) and unresectable patients (P = 0.014) into subgroups with different prognosis based on RSS scores. CONCLUSIONS Based on a comprehensive and systematic quantitative approach, we developed a scoring system that demonstrated excellent accuracy to predict tumor resection, surgical margin status, and prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Albert C. Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Kloth C, Vogele D, Brunner H, Beer M, Schmidt SA. Pathognomonic imaging signs in abdominal radiology. Abdom Radiol (NY) 2020; 45:576-586. [PMID: 31834459 DOI: 10.1007/s00261-019-02331-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The imaging evaluation of the abdomen is of crucial importance for every radiologist. In addition to ultrasound, conventional radiographs and contrast-enhanced computed tomography (CT) are the most common imaging procedures in the abdominal region. Numerous pathognomonic signs should be known in this context by every radiologist. Radiographs of the abdomen are an often used first step in radiologic imaging, while CT examinations are carried out for further differentiation, in oncological settings and in time-critical emergency situations. A fast and clear assignment of these signs to a specific disease is the basis for a correct diagnosis. This pictorial review describes the most common pathognomonic signs in abdominal imaging. The knowledge of these pictograms is therefore essential for radiologists interested in abdominal medicine and should also be addressed in training and further education.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Stefan Andreas Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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15
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CT and MR features that can help to differentiate between focal chronic pancreatitis and pancreatic cancer. Radiol Med 2020; 125:356-364. [PMID: 31933064 DOI: 10.1007/s11547-019-01132-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023]
Abstract
Diagnosis of a focal pancreatic mass in routine clinical practice can be a challenge because patients with chronic pancreatitis may present with symptoms and imaging findings that can be difficult to distinguish from pancreatic cancer. Markers, such as cancer antigen 19-9 and carcinoembryonic antigen, are helpful if abnormal, but normal values do not rule out pancreatic cancer. One of the strongest complicating factors is that chronic pancreatitis is a risk factor for pancreatic cancer. Transition of chronic pancreatitis to pancreatic cancer is relatively rare, but it normally has a poor prognosis because diagnosis is often delayed. From a radiologic diagnosis perspective, the classic so-called double-duct sign is helpful. This sign is considered a hallmark sign of pancreatic cancer on magnetic resonance cholangiopancreatography, but it can also be identified in patients with chronic pancreatitis or with other conditions. A number of additional imaging findings or signs are, therefore, necessary. The aim of this article was to describe the strong CT and MR imaging features or integrated imaging features that can help to differentiate between pancreatic cancer and focal chronic pancreatitis.
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16
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Wittel UA, Lubgan D, Ghadimi M, Belyaev O, Uhl W, Bechstein WO, Grützmann R, Hohenberger WM, Schmid A, Jacobasch L, Croner RS, Reinacher-Schick A, Hopt UT, Pirkl A, Oettle H, Fietkau R, Golcher H. Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma - results of the Conko-007 multicenter trial. BMC Cancer 2019; 19:979. [PMID: 31640628 PMCID: PMC6805375 DOI: 10.1186/s12885-019-6148-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/10/2019] [Indexed: 01/05/2023] Open
Abstract
Background One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. Methods Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. Results One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). Conclusion Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. Trial registration EudraCT:2009-014476-21 (2013-02-22) and NCT01827553 (2013-04-09).
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Affiliation(s)
- U A Wittel
- Department for General- und Visceral Surgery, Medical Center and Faculty of Medicine University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - D Lubgan
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Ghadimi
- Department of General, Visceral and Pediatric Surgery, Medical Center Georg-August-University Göttingen, Göttingen, Germany
| | - O Belyaev
- Department of Surgery, St. Josef Hospital Ruhr-University Bochum, Bochum, Germany
| | - W Uhl
- Department of Surgery, St. Josef Hospital Ruhr-University Bochum, Bochum, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital and Clinics, Frankfurt, Germany
| | - R Grützmann
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - W M Hohenberger
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Schmid
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - L Jacobasch
- Private Practice, Hematology/Oncology, Dresden, Germany
| | - R S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - A Reinacher-Schick
- Department for Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - U T Hopt
- Department for General- und Visceral Surgery, Medical Center and Faculty of Medicine University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - A Pirkl
- Medical Centre for Information and Communication Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Oettle
- Outpatient Department Hematology/Oncology, Friedrichshafen, Germany
| | - R Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Golcher
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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17
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Shen YN, Guo CX, Pan Y, Chen YW, Tang TY, Li YW, Lu JH, Jin G, Qin RY, Yao WY, Liang TB, Bai XL. Preoperative prediction of peripancreatic vein invasion by pancreatic head cancer. Cancer Imaging 2018; 18:49. [PMID: 30526690 PMCID: PMC6288927 DOI: 10.1186/s40644-018-0179-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022] Open
Abstract
Background Pancreatic adenocarcinoma is often diagnosed at an advanced stage when adjacent vascular invasion is present. Accurate evaluation of presence of vascular invasion can help guide therapy. The aim of this study was to construct a nomogram for preoperative prediction of peripancreatic vein invasion in patients with pancreatic head cancer. Study design Data of patients with carcinoma head of pancreas and suspected peripancreatic invasion (n = 247) who underwent pancreatic resection with venous reconstruction between January 2012 and January 2017 at four academic institutions were retrospectively analyzed. Univariate and multivariate analyses were used to identify independent risk factors for vein invasion from among demographic, biological, conditional host-related, and anatomical data. A predictive nomogram was constructed based on the identified independent risk factors. Results The nomogram was constructed using data from 181 patients while the validation cohort consisted of 66 patients. Length of tumor contact (P = 0.031), circumferential vein involvement (P = 0.048), and venous contour abnormalities (P = 0.001) were independent predictors of venous invasion. The C-index of the model in predicting venous invasion was 0.963 for the external validation cohort. Patients could be assigned into low- (< 50%), intermediate- (50–90%), and high-risk (> 90%) groups based on the nomogram to facilitate personalized management. Conclusions Vein invasion by pancreatic head cancer is mainly associated with anatomical factors. The nomogram for prediction of vein invasion was found to be practicable. Electronic supplementary material The online version of this article (10.1186/s40644-018-0179-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi-Nan Shen
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Cheng-Xiang Guo
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Yao Pan
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.,Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Wen Chen
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Tian-Yu Tang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Yu-Wei Li
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Jun-Hua Lu
- The 5th Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai, China
| | - Gang Jin
- Department of General Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Ren-Yi Qin
- Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Yun Yao
- Department of General Surgery, The People's Hospital of Changxing County, Huzhou, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China. .,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
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18
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Toshima F, Inoue D, Komori T, Minehiro K, Yoneda N, Yoshida K, Matsubara T, Izumozaki A, Kobayashi S, Gabata T. Qualitative and quantitative evaluation for morphological changes of the splenic artery in autoimmune pancreatitis: novel imaging findings for differentiation from pancreatic adenocarcinoma. Abdom Radiol (NY) 2018; 43:3357-3366. [PMID: 29948059 DOI: 10.1007/s00261-018-1634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine whether morphological changes can occur in the splenic artery (SPA) of autoimmune pancreatitis (AIP) cases, and if present, to compare them with those in pancreatic adenocarcinoma (PAC) to clarify any arterial morphological differences between AIP and PAC. METHODS A total of 101 AIP cases were included in this study. The presence or absence of morphological change in the SPA was assessed, using arterial phase axial computed tomography images. Subsequently, imaging parameters (imaging pattern, capsule-like rim, other organ involvement, splenic vein [SPV] stenosis, and SPA calcification) were compared between cases with and without morphological changes. Additionally, comparison analyses (visual SPA assessment and % minimal lumen diameter [MLD] stenosis) among normal pancreas, PAC, and AIP groups were performed using early arterial phase (EAP) reconstructed images. RESULTS In 25 (24.8%) AIP cases, marginal irregularities of the SPA were present. The presence of the capsule-like rim and SPV stenosis were significantly associated with the arterial morphological changes. All cases with morphological changes had a capsule-like rim. Visual assessment using EAP reconstructed images revealed irregularities of the SPA in 9 of 38 AIP cases (23.7%); however, arterial narrowing was not detected in any cases. % MLD stenosis in AIP group was significantly lower than that in PAC group (p < 0.0001). CONCLUSIONS Although approximately one-quarter of AIP cases potentially demonstrate marginal irregularity in the SPA when it is surrounded by an apparent capsule-like rim, arterial luminal narrowing rarely occurs in contrast to PAC. These arterial findings can help to distinguish AIP from PAC.
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Affiliation(s)
- Fumihito Toshima
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan.
| | - Takahiro Komori
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Kaori Minehiro
- Department of Radiological Technology, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Kotaro Yoshida
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Takashi Matsubara
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Akira Izumozaki
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa, 920-8640, Japan
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Zhou Q, Guan Y, Mao L, Zhu Y, Chen J, Shi J, Tang M, Qiu Y, Zhu B, He J. Modification and establishment of CT criteria in preoperative assessment of portal venous invasion by hilar cholangiocarcinoma. HPB (Oxford) 2018; 20:1163-1171. [PMID: 30030081 DOI: 10.1016/j.hpb.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/09/2018] [Accepted: 05/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND To compare the diagnostic performance of CT criteria and to establish a new model in evaluating portal venous invasion by hilar cholangiocarcinoma. METHODS CT images of 67 patients with hilar cholangiocarcinoma were retrospectively reviewed. Modified Loyer's, Lu's and Li's standard introduced from pancreatic cancer were used to evaluate portal venous invasion with the reference of intraoperative findings and/or postoperative pathological diagnosis. A new model was constructed with modified Lu's standard and contact length between portal vein and tumor. RESULTS The modified Loyer's standard, modified Lu's standard and Li's standard showed a sensitivity of 86.7%, 83.3%, 70.0%, a specificity of 89.4%, 95.7%, 95.7% and an accuracy of 88.6%, 92.0%, 88.1%, respectively. CT criteria performed better in evaluating left branch. The new model performed significantly better than any CT criterion or contact length, with a sensitivity of 95.0%, a specificity of 96.5% and an accuracy of 96.0%. CONCLUSIONS Modified Lu's standard performed best in evaluating portal venous invasion by hilar cholangiocarcinoma among three CT criteria. The left branch invasion could be evaluated by CT criteria better than the right branch and the trunk of portal vein. The new mode significantly improved the diagnostic performance of portal venous invasion by hilar cholangiocarcinoma.
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Affiliation(s)
- Qun Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Yue Guan
- School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Liang Mao
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yong Zhu
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210008, China
| | - Jun Chen
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jiong Shi
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Min Tang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yudong Qiu
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Bin Zhu
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China; Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Shen YN, Bai XL, Jin G, Zhang Q, Lu JH, Qin RY, Yu RS, Pan Y, Chen Y, Sun PW, Guo CX, Li X, Ma T, Li GG, Gao SL, Lou JY, Que RS, Lau WY, Liang TB. A preoperative nomogram predicts prognosis of up front resectable patients with pancreatic head cancer and suspected venous invasion. HPB (Oxford) 2018; 20:1034-1043. [PMID: 29929784 DOI: 10.1016/j.hpb.2018.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/05/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a preoperative prognostic nomogram for patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peripancreatic venous invasion. METHODS Data on all consecutive patients were retrospectively collected from 2012 to 2016 at four academic institutions. The demographic and radiological parameters were analyzed using univariate and multivariate Cox regression analyses. The final nomogram was established using the concordance Harrell's C-indices and calibration curves from data obtained in three institutions and validated in the cohort of patients coming from the fourth institution. RESULTS The nomogram was constructed using data from 178 patients while the validation cohort consisted of 61 patients. Age, length of tumor contact, peripancreatic venous abnormalities and lymph node staging were independent factors of overall survival. The nomogram showed good probabilities of survival on calibration curves. The C-index of the model in predicting overall survival (OS) was 0.824 for the validation cohort. CONCLUSIONS The nomogram accurately predicted OS in patients with pancreatic head cancer with suspected peripancreatic venous invasion after attempted curative pancreatic resectional surgery.
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Affiliation(s)
- Yi-Nan Shen
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Gang Jin
- Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Jun-Hua Lu
- The 5th Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Ren-Yi Qin
- Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ri-Sheng Yu
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China; Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Pan
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China; Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Chen
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China; Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pei-Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Cheng-Xiang Guo
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Xiang Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Guo-Gang Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Shun-Liang Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Jian-Ying Lou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Ri-Sheng Que
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Wan Y Lau
- Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong, SAR, China.
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.
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Kim M, Kang TW, Cha DI, Kim YK, Kim SH, Jang KT, Han IW, Sohn I. Prediction and clinical implications of portal vein/superior mesenteric vein invasion in patients with resected pancreatic head cancer: the significance of preoperative CT parameters. Clin Radiol 2018; 73:564-573. [PMID: 29519500 DOI: 10.1016/j.crad.2018.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Abstract
AIM To determine the preoperative computed tomography (CT) parameters that predict portal vein/superior mesenteric vein (PV-SMV) invasion in patients with pancreatic head cancer, and to assess whether PV-SMV invasion affects patient survival. MATERIALS AND METHODS Sixty patients with PV-SMV invasion, and 60 randomly selected patients without it, who had undergone preoperative CT and subsequent surgery for pancreatic head cancer were enrolled. The following CT parameters were evaluated using multivariate logistic regression and receiver operating characteristic analyses to predict vessel invasion (tumour size and margin, length of involved vessel, distance from the tumour to the vessel, vessel irregularity, the teardrop sign, and tumour-vein interface [TVI]). The Cox proportional hazard model was used to evaluate the effects of PV-SMV invasion on survival. RESULTS In multivariate analysis, tumour size (odds ratio [OR]=1.99) and TVI (OR=3.79 [≤90°], 20.66 [>90°, ≤180°], and 47.24 [>180°]) were independent CT predictors of PV-SMV invasion (p<0.05); they achieved a sensitivity of 87%, a specificity of 75%, and an accuracy of 81%; however, PV-SMV invasion did not affect patient survival after surgery (p=0.374). CONCLUSION In patients with pancreatic head cancer, preoperative CT parameters can predict PV-SMV invasion with high accuracy. PV-SMV invasion did not affect treatment outcome after surgery.
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Affiliation(s)
- M Kim
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - T W Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - D I Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y K Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S H Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K-T Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - I W Han
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - I Sohn
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
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Establishment and Verification of a Scoring Model for the Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis. Pancreas 2018. [PMID: 29517635 DOI: 10.1097/mpa.0000000000001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aims of this study were to establish a scoring model for the differential diagnosis of pancreatic cancer (PC) and chronic pancreatitis (CP) and to evaluate its diagnostic efficacy. METHODS The data of 502 patients with PC and 210 patients with CP at the Peking Union Medical College Hospital from January 1999 to December 2013 were retrospectively analyzed. Binary logistic regression was applied to establish the prediction model for the differential diagnosis. The model was verified using the method of leave-one-out cross-validation. RESULTS The scoring system was established with 5 variables including age, carbohydrate antigen 19-9 level, splenic vein invasion, irregular dilatation of the pancreatic duct, and nontruncated pancreatic duct stenosis. The score range was from -2 to 3. The area under the receiver operating characteristic curve of the objects was 0.779 (95% confidence interval, 0.744-0.814) (P < 0.01), indicating that the scoring system is good at differentiation of PC with CP. With a score of 1 as the diagnostic cut-off value, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were 71.3%, 69.0%, 70.0%, 71.4%, and 70.2%, respectively. CONCLUSIONS The scoring model may improve the differential diagnosis of PC and CP and be useful in clinical practice.
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23
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Kang MJ, Jang JY, Kwon W, Kim SW. Clinical significance of defining borderline resectable pancreatic cancer. Pancreatology 2018; 18:139-145. [PMID: 29274720 DOI: 10.1016/j.pan.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
Since the introduction of the concept of borderline resectable pancreatic cancer (BRPC), various definitions of this disease entity have been suggested. However, there are several obstacles in defining this disease category. The current diagnostic criteria of BRPC mainly focuses on its expanded 'technical resectability'; however, they are difficult to interpret because of their ambiguity using potential subjective or arbitrary terminology, In addition, limitations in current imaging technology and a lack of evidence in radiological-pathological-clinical correlation make it difficult to refine the criteria. On the other hand, neoadjuvant treatment is usually applied to increase the R0 resection rate of BRPC focusing on the 'oncological curability'. However, evidence is needed concerning the effect of neoadjuvant treatment by quality-controlled prospective randomized clinical trials based on a standardized radiologic and pathologic reporting system. In conclusion, there are two aspects in the current concept of BRPC, which are technical resectability and oncological curability. Although the recent evolution of surgical techniques is expanding the scope of technical resectability, it should not be overlooked that the disease entity must be defined based on the evidence of oncological curability.
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Affiliation(s)
- Mee Joo Kang
- Korea International Cooperation Agency, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Montejo Gañán I, Ángel Ríos L, Sarría Octavio de Toledo L, Martínez Mombila M, Ros Mendoza L. Staging pancreatic carcinoma by computed tomography. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Montejo Gañán I, Ángel Ríos LF, Sarría Octavio de Toledo L, Martínez Mombila ME, Ros Mendoza LH. Staging pancreatic carcinoma by computed tomography. RADIOLOGIA 2018; 60:10-23. [PMID: 29078990 DOI: 10.1016/j.rx.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 02/08/2023]
Abstract
Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique.
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Affiliation(s)
- I Montejo Gañán
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - L F Ángel Ríos
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - M E Martínez Mombila
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L H Ros Mendoza
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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26
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Somers I, Bipat S. Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT. Eur Radiol 2017; 27:3408-3435. [PMID: 28093626 PMCID: PMC5491588 DOI: 10.1007/s00330-016-4708-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/29/2016] [Accepted: 12/15/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To obtain a summary positive predictive value (sPPV) of contrast-enhanced CT in determining resectability. METHODS The MEDLINE and EMBASE databases from JAN2005 to DEC2015 were searched and checked for inclusion criteria. Data on study design, patient characteristics, imaging techniques, image evaluation, reference standard, time interval between CT and reference standard, and data on resectability/unresectablity were extracted by two reviewers. We used a fixed-effects or random-effects approach to obtain sPPV for resectability. Several subgroups were defined: 1) bolus-triggering versus fixed-timing; 2) pancreatic and portal phases versus portal phase alone; 3) all criteria (liver metastases/lymphnode involvement/local advanced/vascular invasion) versus only vascular invasion as criteria for unresectability. RESULTS Twenty-nine articles were included (2171 patients). Most studies were performed in multicentre settings, initiated by the department of radiology and retrospectively performed. The I2-value was 68%, indicating heterogeneity of data. The sPPV was 81% (95%CI: 75-86%). False positives were mostly liver, peritoneal, or lymphnode metastases. Bolus-triggering had a slightly higher sPPV compared to fixed-timing, 87% (95%CI: 81-91%) versus 78% (95%CI: 66-86%) (p = 0.077). No differences were observed in other subgroups. CONCLUSIONS This meta-analysis showed a sPPV of 81% for predicting resectability by CT, meaning that 19% of patients falsely undergo surgical exploration. KEY POINTS • Predicting resectability of pancreatic cancer by CT is 81% (95%CI: 75-86%). • The percentage of patients falsely undergoing surgical exploration is 19%. • The false positives are liver metastases, peritoneal metastases, or lymph node metastases.
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Affiliation(s)
- Inne Somers
- Department of Radiology, Academic Medical Centre, University of Amsterdam, G1-212, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Academic Medical Centre, University of Amsterdam, G1-212, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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27
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Gleason JB, Tashtoush B, Mehta J, Savage E, Martinez F, Mehta AC. Pulmonary Artery Invasion Caused by Mycobacterium tuberculosis. Chest 2017; 150:e99-e103. [PMID: 27719830 DOI: 10.1016/j.chest.2016.02.655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/10/2016] [Accepted: 02/18/2016] [Indexed: 02/01/2023] Open
Abstract
Extrapulmonary tuberculosis refers to Mycobacterium tuberculosis involving organs other than the lungs (eg, pleura, lymph nodes, genitourinary tract, abdomen, skin, joints and bones, or meninges). In non-HIV-endemic areas, where reactivation is the predominant mechanism of tuberculosis, pleural involvement occurs in 4% of cases. We present an extremely rare case of a 62-year-old immunocompetent patient with pleural tuberculosis confirmed by surgical pleural biopsies, who presented with a large mediastinal mass and evidence of pulmonary artery invasion on CT scanning and endobronchial ultrasonography imaging, highlighting a unique and malignant-like character of the disease.
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Affiliation(s)
- James Benjamin Gleason
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL.
| | - Basheer Tashtoush
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL
| | - Jinesh Mehta
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL
| | - Edward Savage
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston, FL
| | - Felipe Martinez
- Department of Radiology, Cleveland Clinic Florida, Weston, FL
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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28
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Shen YN, Bai XL, Li GG, Liang TB. Review of radiological classifications of pancreatic cancer with peripancreatic vessel invasion: are new grading criteria required? Cancer Imaging 2017; 17:14. [PMID: 28477615 PMCID: PMC5420088 DOI: 10.1186/s40644-017-0115-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/27/2017] [Indexed: 12/11/2022] Open
Abstract
Pancreatic cancer is mainly diagnosed at an advanced stage when adjacent vessel invasion is present; however, radical resection is potentially curative for selected patients with adjacent vessel invasion. Therefore, accurately judging the resectability of patients with adjacent vessel invasion represents a crucially important step in diagnosis and treatment. Currently, decisions regarding resectability are based on imaging studies, commonly contrast computed tomography (CT). Several radiological classifications have been published for vascular infiltration in pancreatic cancer. However, radiologists always formulate these CT grading systems according to their own experience, resulting in different judgment methods and parameters. And it is controversial in evaluating performance and clinical application. Besides, the conventional CT grading systems mainly focus on the evaluation of vessel invasion so as to less on the outcome of patient evaluation. In this review, we summarize the mainstream CT grading systems for vascular invasion in pancreatic cancer, with the aim of improving the clinical value of CT grading systems for predicting resectability and survival.
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Affiliation(s)
- Y N Shen
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Jiefang Road, Shangcheng District, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - X L Bai
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Jiefang Road, Shangcheng District, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - G G Li
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Jiefang Road, Shangcheng District, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - T B Liang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Jiefang Road, Shangcheng District, Hangzhou, China. .,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.
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29
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Teramura K, Noji T, Nakamura T, Asano T, Tanaka K, Nakanishi Y, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S. Preoperative diagnosis of portal vein invasion in pancreatic head cancer: appropriate indications for concomitant portal vein resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:643-649. [PMID: 27474882 DOI: 10.1002/jhbp.387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Koichi Teramura
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; North-15, West-7 Kita-ku, Sapporo, Hokkaido 060-8638 Japan
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Helmink BA, Snyder RA, Idrees K, Merchant NB, Parikh AA. Advances in the Surgical Management of Resectable and Borderline Resectable Pancreas Cancer. Surg Oncol Clin N Am 2016; 25:287-310. [PMID: 27013365 PMCID: PMC10181830 DOI: 10.1016/j.soc.2015.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Successful surgical resection offers the only chance for cure in patients with pancreatic cancer. However, pancreatic resection is feasible in less than 20% of the patients. In this review, the current state of surgical management of pancreatic cancer is discussed. The definition of resectability based on cross-sectional imaging and the technical aspects of surgery, including vascular resection and/or reconstruction, management of aberrant vascular anatomy and extent of lymphadenectomy, are appraised. Furthermore, common pancreatic resection-specific postoperative complications and their management are reviewed.
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Affiliation(s)
- Beth A Helmink
- Division of Surgical Oncology, Vanderbilt University Medical Center, 597 PRB, 2220 Pierce Avenue, Nashville, TN 37232, USA
| | - Rebecca A Snyder
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit Number: 1484, Houston, TX 77030, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Vanderbilt University Medical Center, 597 PRB, 2220 Pierce Avenue, Nashville, TN 37232, USA
| | - Nipun B Merchant
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Medical Center, 1120 Northwest 14th Street, Clinical Research Building, Suite 410, Miami, FL 33136, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, Vanderbilt University Medical Center, 597 PRB, 2220 Pierce Avenue, Nashville, TN 37232, USA.
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Chua T, de Reuver P, Staerkle R, Neale M, Arena J, Mittal A, Shanbhag S, Gill A, Samra J. Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy. Eur J Surg Oncol 2016; 42:211-8. [DOI: 10.1016/j.ejso.2015.08.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/23/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022] Open
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Gluth A, Werner J, Hartwig W. Surgical resection strategies for locally advanced pancreatic cancer. Langenbecks Arch Surg 2015; 400:757-65. [DOI: 10.1007/s00423-015-1318-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 02/07/2023]
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Mullapudi B, Hawkes PJ, Patel A, Are C, Misra S. Borderline resectable pancreatic cancer. Indian J Surg Oncol 2015; 6:63-68. [PMID: 25937766 DOI: 10.1007/s13193-014-0374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
Borderline resectable pancreatic cancer (BRPC) is an evolving diagnostic entity that blurs the distinction between resectable and locally advanced pancreatic cancer (Varadhachary et al. Ann Surg Oncol 13:1035-1046, 2006). Until recently the management of this disease has been poorly defined; however, consensus guidelines have been developed regarding the proper management of this diagnostic entity. Recent studies have shown that if appropriately identified and treated, this subset of disease can have outcomes similar to pancreatic cancer that is defined as resectable (Laurence et al. J Gastrointest Surg 15:2059-2069, 2011). The aim of this review is to outline the current consensus on definitions, workup and management of BRPC, and also provide a summary of issues that require progress as defined by the International Study Group of Pancreatic Surgery (ISGPS).
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Affiliation(s)
- Bhargava Mullapudi
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Patrick J Hawkes
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Asish Patel
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Subhasis Misra
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 S Coulter St, Amarillo, TX 79106 USA
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Kawabata Y, Hayashi H, Takai K, Kidani A, Tajima Y. Superior mesenteric artery-first approach in radical antegrade modular pancreatosplenectomy for borderline resectable pancreatic cancer: a technique to obtain negative tangential margins. J Am Coll Surg 2015; 220:e49-54. [PMID: 25840548 DOI: 10.1016/j.jamcollsurg.2014.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/27/2014] [Accepted: 12/29/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan.
| | - Hikota Hayashi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
| | - Akihiko Kidani
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
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Hirono S, Yamaue H. Tips and tricks of the surgical technique for borderline resectable pancreatic cancer: mesenteric approach and modified distal pancreatectomy with en-bloc celiac axis resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:E4-7. [PMID: 25366360 DOI: 10.1002/jhbp.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Borderline resectable (BR) pancreatic cancer involves the portal vein and/or superior mesenteric vein (PV/SMV), major arteries including the superior mesenteric artery (SMA) or common hepatic artery (CHA), and sometimes includes the involvement of the celiac axis. We herein describe tips and tricks for a surgical technique with video assistance, which may increase the R0 rates and decrease the mortality and morbidity for BR pancreatic cancer patients. First, we describe the techniques used for the "artery-first" approach for BR pancreatic cancer with involvement of the PV/SMV and/or SMA. Next, we describe the techniques used for distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) and tips for decreasing the delayed gastric emptying (DGE) rates for advanced pancreatic body cancer. The mesenteric approach, followed by the dissection of posterior tissues of the SMV and SMA, is a feasible procedure to obtain R0 rates and decrease the mortality and morbidity, and the combination of this aggressive procedure and adjuvant chemo(radiation) therapy may improve the survival of BR pancreatic cancer patients. The DP-CAR procedure may increase the R0 rates for pancreatic cancer patients with involvement within 10 mm from the root of the splenic artery, as well as the CHA or celiac axis, and preserving the left gastric artery may lead to a decrease in the DGE rates in cases where there is more than 10 mm between the tumor edge and the root of the left gastric artery. The development of safer surgical procedures is necessary to improve the survival of BR pancreatic cancer patients.
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Affiliation(s)
- Seiko Hirono
- Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Hassanen O, Ghieda U, Eltomey MA. Assessment of vascular invasion in pancreatic carcinoma by MDCT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2014; 155:977-88. [PMID: 24856119 DOI: 10.1016/j.surg.2014.02.001] [Citation(s) in RCA: 645] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND This position statement was developed to expedite a consensus on definition and treatment for borderline resectable pancreatic ductal adenocarcinoma (BRPC) that would have worldwide acceptability. METHODS An international panel of pancreatic surgeons from well-established, high-volume centers collaborated on a literature review and development of consensus on issues related to borderline resectable pancreatic cancer. RESULTS The International Study Group of Pancreatic Surgery (ISGPS) supports the National Comprehensive Cancer Network criteria for the definition of BRPC. Current evidence supports operative exploration and resection in the case of involvement of the mesentericoportal venous axis; in addition, a new classification of extrahepatic mesentericoportal venous resections is proposed by the ISGPS. Suspicion of arterial involvement should lead to exploration to confirm the imaging-based findings. Formal arterial resections are not recommended; however, in exceptional circumstances, individual therapeutic approaches may be evaluated under experimental protocols. The ISGPS endorses the recommendations for specimen examination and the definition of an R1 resection (tumor within 1 mm from the margin) used by the British Royal College of Pathologists. Standard preoperative diagnostics for BRPC may include: (1) serum levels of CA19-9, because CA19-9 levels predict survival in large retrospective series; and also (2) the modified Glasgow Prognostic Score and the neutrophil/lymphocyte ratio because of the prognostic relevance of the systemic inflammatory response. Various regimens of neoadjuvant therapy are recommended only in the setting of prospective trials at high-volume centers. CONCLUSION Current evidence justifies portomesenteric venous resection in patients with BRPC. Basic definitions were identified, that are currently lacking but that are needed to obtain further evidence and improvement for this important patient subgroup. A consensus for each topic is given.
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Affiliation(s)
- Maximilian Bockhorn
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Faik G Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mustapha Adham
- Department of HPB Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Clem Imrie
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Miroslav Milicevic
- First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Aken A Sandberg
- Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Horacio J Asbun
- Department of General Surgery, Mayo Clinic, Jacksonville, FL
| | - Claudio Bassi
- Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy
| | - Markus Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Richard M Charnley
- Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Kevin Conlon
- Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland
| | - Laureano Fernandez Cruz
- Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Abe Fingerhutt
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Werner Hartwig
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marco Montorsi
- Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy
| | - John P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK
| | - Shailesh V Shrikhande
- Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Kyoichi Takaori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - William Traverso
- St. Luke's Clinic - Center For Pancreatic and Liver Diseases, Boise, ID
| | - Yogesh K Vashist
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Charles Vollmer
- Department of Gastrointestinal Surgery, Penn Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Oliva C, Olivares S, Caruso R, Ferri V, Ceron R, Moreno A. Is arterial infiltration still a criterion for unresectability in pancreatic adenocarcinoma? Cir Esp 2014; 92:305-15. [PMID: 24636076 DOI: 10.1016/j.ciresp.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/04/2013] [Indexed: 12/20/2022]
Abstract
As surgical resection remains the only hope for cure in pancreatic cancer (PC), more aggressive surgical approaches have been advocated to increase resection rates. Venous resection demonstrated to be a feasible technique in experienced centers, increasing survival. In contrast, arterial resection is still an issue of debate, continuing to be considered a general contraindication to resection. In the last years there have been significant advances in surgical techniques and postoperative management which have dramatically reduced mortality and morbidity of major pancreatic resections. Furthermore, advances in multimodal neo-adjuvant and adjuvant treatments, as well as the better understanding of tumor biology and new diagnostic options have increased overall survival. In this article we highlight some of the important points that a modern pancreatic surgeon should take into account in the management of PC with arterial involvement in light of the recent advances.
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Affiliation(s)
- Emilio Vicente
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España.
| | - Yolanda Quijano
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Benedetto Ielpo
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Hipolito Duran
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Eduardo Diaz
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Isabel Fabra
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Catalina Oliva
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Sergio Olivares
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Riccardo Caruso
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Valentina Ferri
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Ricardo Ceron
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Almudena Moreno
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
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Shokry A, Mokhtar O, Salah A, Gomaa M, Abdelmottelb A. Preoperative assessment of vascular invasion in exocrine pancreatic cancer by multidetector CT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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40
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Nagamachi S, Nishii R, Wakamatsu H, Mizutani Y, Kiyohara S, Fujita S, Futami S, Sakae T, Furukoji E, Tamura S, Arita H, Chijiiwa K, Kawai K. The usefulness of (18)F-FDG PET/MRI fusion image in diagnosing pancreatic tumor: comparison with (18)F-FDG PET/CT. Ann Nucl Med 2013; 27:554-63. [PMID: 23580090 DOI: 10.1007/s12149-013-0719-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/17/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed at demonstrating the feasibility of retrospectively fused (18)F FDG-PET and MRI (PET/MRI fusion image) in diagnosing pancreatic tumor, in particular differentiating malignant tumor from benign lesions. In addition, we evaluated additional findings characterizing pancreatic lesions by FDG-PET/MRI fusion image. METHODS We analyzed retrospectively 119 patients: 96 cancers and 23 benign lesions. FDG-PET/MRI fusion images (PET/T1 WI or PET/T2WI) were made by dedicated software using 1.5 Tesla (T) MRI image and FDG-PET images. These images were interpreted by two well-trained radiologists without knowledge of clinical information and compared with FDG-PET/CT images. We compared the differential diagnostic capability between PET/CT and FDG-PET/MRI fusion image. In addition, we evaluated additional findings such as tumor structure and tumor invasion. RESULTS FDG-PET/MRI fusion image significantly improved accuracy compared with that of PET/CT (96.6 vs. 86.6 %). As additional finding, dilatation of main pancreatic duct was noted in 65.9 % of solid types and in 22.6 % of cystic types, on PET/MRI-T2 fusion image. Similarly, encasement of adjacent vessels was noted in 43.1 % of solid types and in 6.5 % of cystic types. Particularly in cystic types, intra-tumor structures such as mural nodule (35.4 %) or intra-cystic septum (74.2 %) were detected additionally. Besides, PET/MRI-T2 fusion image could detect extra benign cystic lesions (9.1 % in solid type and 9.7 % in cystic type) that were not noted by PET/CT. CONCLUSIONS In diagnosing pancreatic lesions, FDG-PET/MRI fusion image was useful in differentiating pancreatic cancer from benign lesions. Furthermore, it was helpful in evaluating relationship between lesions and surrounding tissues as well as in detecting extra benign cysts.
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Affiliation(s)
- Shigeki Nagamachi
- Department of Radiology, School of Medicine, Miyazaki University, 5200 Kihara, Kiyotake, Miyazaki-city, Miyazaki Prefecture, 889-1692, Japan.
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Li AE, Li BT, Ng BH, McCormack S, Vedelago J, Clarke S, Pavlakis N, Samra J. Diagnostic Accuracy of Imaging Modalities in the Evaluation of Vascular Invasion in Pancreatic Adenocarcinoma: A Meta-Analysis. World J Oncol 2013; 4:74-82. [PMID: 29147335 PMCID: PMC5649672 DOI: 10.4021/wjon657w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The extent of vascular invasion is a key factor determining the resectability of non-metastatic pancreatic adenocarcinoma. The purpose of this study is to determine the diagnostic accuracy of computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) in the pre-operative evaluation of vascular invasion in pancreatic adenocarcinoma, with surgery as the reference standard. METHODS A search of the MEDLINE database for relevant articles in the English language published between January 2000 and February 2009 was performed. From each study, 2 × 2 tables were obtained, and pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and diagnostic odds ratios were calculated for each modality, along with a summary receiver operating characteristics (SROC) curve. RESULTS 16 studies with a total of 797 patients who had surgical assessment of vascular invasion were included in the analysis. Several studies evaluated more than one imaging modality, allowing 24 datasets to be obtained in total. Sensitivity was highest for CT (0.73, 95% CI 0.67 - 0.79), followed by EUS (0.66, 95% CI 0.56 - 0.75) and MRI (0.63, 95% CI 0.48 - 0.77). The specificity for all three imaging modalities was comparable. The diagnostic odds ratios for CT, EUS and MRI were 45.9 (95% CI 18.0 - 117.4), 23.0 (95%CI 9.4 - 56.6), 23.9 (95% CI 5.4 - 105.1) respectively. CONCLUSION CT was more accurate than EUS and MRI in the evaluation of vascular invasion in pancreatic adenocarcinoma and should be the first line investigation in pre-operative staging.
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Affiliation(s)
- Angela E. Li
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia
| | - Bob T. Li
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Australia
- Sydney Medical School, University of Sydney, Camperdown NSW 2050, Australia
| | - Bernard H.K. Ng
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia
| | - Sam McCormack
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia
| | | | - Stephen Clarke
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Australia
- Sydney Medical School, University of Sydney, Camperdown NSW 2050, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Australia
- Sydney Medical School, University of Sydney, Camperdown NSW 2050, Australia
| | - Jaswinder Samra
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards NSW 2065, Australia
- Sydney Medical School, University of Sydney, Camperdown NSW 2050, Australia
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Egorov VI, Petrov RV, Lozhkin MV, Maynovskaya OA, Starostina NS, Chernaya NR, Filippova EM. Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy. World J Gastrointest Surg 2013; 5:51-61. [PMID: 23556062 PMCID: PMC3615305 DOI: 10.4240/wjgs.v5.i3.51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/02/2012] [Accepted: 12/20/2012] [Indexed: 02/06/2023] Open
Abstract
Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type VIIIb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.
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Affiliation(s)
- Vyacheslav I Egorov
- Vyacheslav I Egorov, Ostroumov 14 City Hospital, Department of Surgical Oncology, Sechenov First State Medical University, 117997 Moscow, Russia
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A novel scoring system for arterial invasion of pancreatic body and tail cancer based on multidetector row computed tomography and biomarkers. Pancreatology 2013; 13:161-9. [PMID: 23561974 DOI: 10.1016/j.pan.2012.12.364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 12/05/2012] [Accepted: 12/27/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The absence of major-vessel involvement is a crucial factor in the resectability and prognosis of pancreatic cancer. However, arterial invasion cannot be evaluated adequately using imaging findings alone. We therefore developed a scoring system to assess arterial invasion by pancreatic adenocarcinoma using multidetector row computed tomography (MDCT) and serum tumor markers. METHODS Twenty patients who underwent distal pancreatectomy and splenectomy for pancreatic adenocarcinoma were examined retrospectively using 4-, 16- or 64-row MDCT and serum tumor markers. Splenic arterial invasion was evaluated in terms of length of tumor contact, circumferential involvement (<180° or ≥180°) and deformity of vascular diameter. Preoperative expression of carbohydrate antigen 19-9 (CA19-9), DUPAN-2 and S-Pancreas-1 antigen (SPan-1) were also evaluated. The presence or absence of arterial invasion was confirmed histopathologically in all 20 cases. RESULTS In 11 of 20 cases invasion into splenic arteries was observed histopathologically, mostly involving the external elastic lamina and periarterial nerves. Sensitivity, specificity and accuracy were 100%, 88.9% and 95%, respectively, for length of tumor contact (<16 mm or ≥16 mm), 90.9%, 77.8% and 85% for circumferential involvement (<180° or ≥180°), and 100%, 66.7% and 85% for deformity of vascular diameter. Furthermore, the sensitivity, specificity and accuracy were all increased to 100% when tumor markers were included in the score. CONCLUSIONS MDCT is a useful technique for diagnosing arterial invasion of pancreatic body and tail cancer, even in comparison with pathological examination; however, this new scoring system can be further complemented and made more reliable by measurements of serous tumor markers.
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Calvo F, Guillen Ponce C, Muñoz Beltran M, Sanjuanbenito Dehesa A. Multidisciplinary management of locally advanced–borderline resectable adenocarcinoma of the head of the pancreas. Clin Transl Oncol 2012. [DOI: 10.1007/s12094-012-0962-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kwon HJ, Kim SG. Surgical treatment for advanced pancreatic cancer. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:89-92. [PMID: 26388914 PMCID: PMC4575002 DOI: 10.14701/kjhbps.2012.16.3.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 08/18/2012] [Accepted: 08/20/2012] [Indexed: 12/22/2022]
Abstract
The role of multimodality therapy and surgery for the treatment of locally advanced pancreatic cancer remains to be determined. Although no randomized trials have been done to determine the optimal management of this difficult clinical problem, numerous series reporting successful surgical resection with negative (R0) or microscopic margin (R1) showing favorable long-term survival provide a basis for an aggressive approach in selected cases of advanced cancer of the pancreas. In the absence of conclusive clinical trials, neoadjuvant treatment followed by surgical resection seems to be the optimal approach for locally advanced pancreatic cancers when the potential for surgical resection is suggested by preoperative high quality CT imaging. In particular, when the tumor is within the criteria for borderline resectable pancreatic cancer, efforts to achieve R0 resection are warranted. For those selected cases invading the hepatic artery and superior mesenteric artery, combined arterial resection and reconstruction may be performed to achieve R0 resection. Nonetheless, such a complex procedure should be balanced by a high rate of postoperative complications. In contrast, in cases of tumors invading the celiac axis, R0 resection by combined celiac axis resection can be performed without a high rate of postoperative complications. Survival benefit needs to be verified by further studies in the future.
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Affiliation(s)
- Hyung Jun Kwon
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Sang Geol Kim
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
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Fang CH, Zhu W, Wang H, Xiang N, Fan Y, Yang J, Wang X, Zhong SZ. A new approach for evaluating the resectability of pancreatic and periampullary neoplasms. Pancreatology 2012; 12:364-371. [PMID: 22898639 DOI: 10.1016/j.pan.2012.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To establish a new standard for assessing the resectability of pancreatic and periampullary tumors by the Medical Image Three-Dimensional Visualization System (MI-3DVS). METHODS Eighty cases of pancreatic and periampullary tumors were examined. The 64-slice multidetector CT (64-MDCT) images and patient data were processed by MI-3DVS. The main elements examined by MI-3DVS included tumor shape, size, and location; distribution of related vessels; luminal morphology of large vessels; distribution and morphology of the small peripancreatic veins; morphology, degree of dilation, and obstructive sites of bile and pancreatic ducts. Based on vascular characteristics of MI-3DVS findings, the cases were classified into five types. Type I and II were resectable, type III were potentially resectable or resectable with combined vascular resection and reconstruction, and type IV and V were unresectable. The outcome was then compared with corresponding CT angiography (CTA) analysis and actual surgical observations. RESULTS Among the 80 cases, MI-3DVS indicated that 60 were resectable and the remaining 20 were not. In contrast, CTA indicated 50 resectable cases and 30 unresectable cases. For 57 cases of pancreatic ductal carcinomas and all 80 cases periampullary tumors, MI-3DVS assessment yielded a positive predictive value of 100%, negative predictive value of 100%, a sensitivity of 100%, a specificity of 100%, and an accuracy of 100%. While CTA generated corresponding values of 96%, 60%, 80%, 90%, 82.5%. The overall differences between the two methods were significant (P < 0.05). CONCLUSION The new classification system is able to reliably assess the resectability of pancreatic and periampullary tumors.
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Affiliation(s)
- Chi-hua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, The Southern Medical University, Guangzhou 510282, Guangdong Province, PR China.
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Zakharova OP, Karmazanovsky GG, Egorov VI. Pancreatic adenocarcinoma: Outstanding problems. World J Gastrointest Surg 2012; 4:104-13. [PMID: 22655124 PMCID: PMC3364335 DOI: 10.4240/wjgs.v4.i5.104] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/10/2012] [Accepted: 05/18/2012] [Indexed: 02/06/2023] Open
Abstract
Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%. Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma. About 40% of patients have locally advanced nonresectable disease. In the past, determination of pancreatic cancer resectability was made at surgical exploration. The development of modern imaging techniques has allowed preoperative staging of patients. Institutions disagree about the criteria used to classify patients. Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis. There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition of borderline resectable pancreatic cancer is also lacking. Thus, there is much room for improvement in all aspects of treatment for pancreatic cancer. Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer. With improved surgical techniques and advanced perioperative management, vascular resection and reconstruction are performed more frequently; patients thought once to be unresectable are undergoing radical surgery. However, when attempting heroic surgery, a realistic approach concerning the patient’s age and health status, probability of recovery after surgery, perioperative morbidity and mortality and life quality after tumor resection is necessary.
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Affiliation(s)
- Olga P Zakharova
- Olga P Zakharova, Grigory G Karmazanovsky, Department of Radiology, Vishnevsky Institute of Surgery, 117997 Moscow, Russia
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Assessment of the Interface Between Retroperitoneal Fat Infiltration of Pancreatic Ductal Carcinoma and the Major Artery by Multidetector-Row Computed Tomography: Surgical Outcomes and Correlation with Histopathological Extension. World J Surg 2012; 36:2192-201. [DOI: 10.1007/s00268-012-1618-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Vascular invasion in pancreatic cancer: predictive values for endoscopic ultrasound and computed tomography imaging. Pancreas 2012; 41:636-8. [PMID: 22460727 DOI: 10.1097/mpa.0b013e31823e3632] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To evaluate the accuracy of endoscopic ultrasound (EUS) to determine vascular invasion in patients with pancreatic cancer. METHODS Data were obtained prospectively from patients with a pancreatic lesion who underwent EUS, computed tomographic (CT) imaging, and surgery from March 2005 to March 2010. RESULTS Fifty patients were included with a mean ± SD age 61 ± 11.5 years; 27 (54%) were women. The sensitivity, specificity, positive predictive value, and negative predictive value for EUS were the following: 61.1 (95% CI, 38.6-79.7), 90.3 (95% CI, 75.1-96.7), 78.6 (95% CI, 52.4-92.4), and 80 (95% CI, 64.1-90), respectively. The area under the curve for EUS and that for CT were 0.80 (95% CI, 0.68-0.92) and 0.74 (95% CI, 0.61-0.86), respectively. The positive predictive value for arterial invasion was 100% (95% CI, 61-100) for EUS and 60% (95% CI, 31.3-83.2) for CT. There were no complications associated with the EUS or the CT. CONCLUSION Endoscopic US is a very good option to detect vascular invasion in patients with pancreatic cancer and is especially sensitive for arterial invasion. When it is available, we recommend that it be performed in addition to CT staging.
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Zhang Y, Huang J, Chen M, Jiao LR. Preoperative vascular evaluation with computed tomography and magnetic resonance imaging for pancreatic cancer: a meta-analysis. Pancreatology 2012; 12:227-33. [PMID: 22687378 DOI: 10.1016/j.pan.2012.03.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Vascular invasion (VI) is the most important factor in assessing operability for pancreatic cancer. The accuracy of preoperative vascular staging with computed tomography (CT) and magnetic resonance imaging (MRI) was examined using meta-analysis. METHODS Published articles in pancreatic cancer comparing diagnostic accuracy of CT with MRI for VI confirmed on histology were searched from MEDLINE, EMBASE and ISI Web of Science databases. Pooled sensitivity, specificity, likelihood ratio, summary receiver operating characteristic (SROC) curve and area under curve (AUC) were analysed by SPSS 13.0 and Revmen 5.1. RESULTS Eight studies (n = 296) met the inclusion criteria. The pooled sensitivity of CT and MRI in diagnosing VI was 71% (95% CI, 64-78) and 67% (95% CI, 59-74), pooled specificity 92% (95% CI, 89-95) and 94% (95% CI, 91-96), positive likelihood ratio 6.33 (95% CI, 4.51-8.87) and 6.58 (95% CI, 4.62-9.37), negative likelihood ratio 0.34 (95% CI, 0.27-0.43) and 0.38 (95% CI, 0.30-0.47), and AUCs 0.87 and 0.76 (p = 0.63), respectively. There was no significant difference between CT and MRI for preoperative diagnosis of VI. Subgroup analysis of 4 studies (n = 143) showed no significant difference between CT and MRI in preoperative diagnosis of venous or arterial invasion (p = 0.73 and p = 0.81, respectively). When CT was compared with MRA in 3 studies (n = 110), again there was no significant difference for preoperative staging of VI (p = 0.54). CONCLUSIONS Both CT and MRI are underreporting vascular invasion preoperatively in pancreatic cancer. MRA does not add any additional information on vascular staging when compared with CT and MRI.
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Affiliation(s)
- Yaojun Zhang
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom
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