Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management

Table 1 CT performance in the detection of vascular invasion in more than 50 patients with pancreatic cancer

Studies (yr)	n	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
Megibow et al[24] (1995)	118	47	69	89	28
Raptopoulos et al[208] (1997)	82	NA	NA	NA	96
Sugiyama et al[91] (1997)	73	651	77	NA	NA
McCarthy et al[16] (1998)	67	NA	NA	55/942	95/94
Diehl et al[209] (1998)	89	86	NA	NA	NA
Böttger et al[10] (1998)	255	22.23	96.4	72.7	74.1
Sugiyama et al[88] (1999)	91	644	79	NA	NA
Nakao et al[105] (1999)	55	82.15	74.1	76.7	80
Pietrabissa et al[130] (1999)	50	82	53	NA	NA
Gress et al[89] (1999)	151	15	100	100	60
Squillaci et al[69] (2003)	50	97	100	100	95
House et al[210] (2004)	115	85-876	95-99	83-93	92-98
Soriano et al[8] (2004)	62	67	94	89	80
Li et al[36] (2005)	54	92/797	100/99	NA	NA
Buchs et al[98] (2007)	153	54.58	91.2	66.7	86.1

^1,3,4,5Only evaluated for portal vein invasion;

²PPV of 55% for venous invasion and 94% for arterial invasion; NPV of 95% for venous invasion and 94% for arterial invasion;

⁶Sensitivity of 85% for the superior mesenteric and portal vein invasion, 86% for the superior mesenteric artery invasion, 87% for the celiac trunk invasion; specificity of 95% for the superior mesenteric vein and portal vein involvement, 97% for the superior mesenteric artery invasion, 99% for celiac trunk involvement; PPV of 90% for the superior mesenteric vein and portal vein invasion, 83% for the superior mesenteric artery involvement, 93% for celiac trunk invasion; NPV of 92% for the superior mesenteric vein and portal vein involvement, 98% for the superior mesenteric artery and celiac trunk invasion;

⁷Sensitivity of 92% for venous invasion and 79% for arterial invasion; specificity of 100% for the veins and 99% for the arteries;

⁸For multi-slice CT. CT: Computer tomography; PPV: Positive predictive value; NPV: Negative predictive value; NA: Not available.

Table 2 Recent results of portal resections in pancreatic cancer

Studies (yr)	n	Mortality (%)	Survival at 1 year (%)	Median survival (mo)
Sindelar et al[159] (1989)	20	201	50	12
Tashiro et al[189] (1991)	27	8.4	51.9	NA
Ishikawa et al[74] (1992)	35	5.7	NA	9+/-5
Launois et al[193] (1993)	9	0	NA	6.1
Takahashi et al[156] (1994)	79	16.5	17-61.52	6-14
Allema et al[192] (1994)	20	15	30%	7
Nakao et al[211] (1995)	89	8	5.5-39.63	NA
Nakao et al[190] (1995)	104	8	NA	NA
Roder et al[27] (1996)	31	0	39	8
Fuhrman et al[154] (1996)	23	4	NA	NA
Harrison et al[157] (1996)	58	5	59	13
Leach et al[196] (1998)	31	0	NA	22
Launois et al[188] (1999)	14	0	23	5
Bachellier et al[195] (2001)	21	3.2	NA	13
van Geenen et al[185] (2001)	34	0	55	14
Shibata et al[197] (2001)	23	4	31	6.8-20.64
Hartel et al[212] (2002)	68	4	5	NA
Aramaki et al[194] (2003)	22	4.5	NA	NA
Nakagohri et al[213] (2003)	33	6	35-81	15
Li et al[164] (2004)	79	56	NA	NA
Tseng et al[206] (2004)	110	1	85	23.4
Wagner et al[4] (2004)	51	7.7	NA	NA
Shimada et al[177] (2006)	86	1	7	14
Carrère et al[182] (2006)	45	4.4	8	15
Riediger et al[181] (2006)	53	3.8	9	NA
Fukuda et al[183] (2007)	37	2.4	47.7	NA

¹Included 3 arterial reconstructions. 17 patients benefited from adjunctive radiotherapy;

²17% survival at 1 year if margins were positive (median survival: 6 mo) and 61.5% if margins were negative (median survival: 14 mo);

³Survival at 1 year: 39.6% if the vessel was not invaded, 11.3% if the media was invaded, and 5.5% if the intima was invaded;

⁴Median survival was 6.8 mo if the intima was invaded, 15.3 mo if the intima was spared, and 20.6 mo if there was no true vascular invasion;

⁵5-year survival rate: 23%;

⁶This mortality also includes arterial reconstructions (11 patients);

⁷5-year survival rate: 12%;

⁸3-year survival rate: 22%;

⁹5-year survival rate: 17.9%.