Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability

Table 1 The demographic findings and tumor size in groups

	R0/R1 resection(n = 11)	R2 resection(n = 8)	Bypass(n = 12)	PKruskal-Wallis
Age (yr)	61 (59-65)	69 (65-72)	62 (60-68)	0.122
Male/female	5/6	4/4	3/9	-
Tumor size (cm)	4 (4-4.5)	4 (3.9-4.2)	5 (4.5-5.5)1	0.001

¹Tumor size was measured without tumor removal.

Table 2 The characteristics of patients who underwent radical (R0-1) surgery for pancreatic ductal adenocarcinoma with circular arterial involvement on computed tomography (group A)

Stage R factor		PDAC location	Artery involved on CT	ChT	DFS (mo)	Survival (mo)
сT4NхM0	pT3N1M0(R1)	Head	rRHA	+	17	19
сT4NхM0	pT3N1M0(R1)	Body	SMA	+	20	27
сT4NхM0	pT3N1M0(R1)	Body	SMA	+	19	22
сT4N1M0	pT3N1M0(R1)	Head	SMA	+	17	23
сT4NхM0	pT3N0M0 (R1)	Total	CHA	-	12	14
сT4NхM0	pT3N1M0(R1)	Head	SMA + SMA2	+	NA	171
сT4N1M0	pT2N0M0 (R0)	Body	CA and LHA	+	16	161
сT4N1M0	pT3N1M0(R1)	Head	SMA	+	10	12
сT4N1M0	pT3N1M0(R1)	Body	GDA	-	6	8
сT4NхM0	pT4N1M0(R1)	Body	SMA	+	NA	111
сT4N1M0	pT3N1M0(R1)	Head	SMA and CA	+	10	111

¹Alive;

²In case 6 there were two SMA segments involved on CT. SMA: Superior mesenteric artery; rRHA: Replaced right hepatic; LHA: Left hepatic; CA: Celiac artery; GDA: Gastroduodenal artery; PDAC: Pancreatic ductal adenocarcinoma.

Table 3 The characteristics of patients who underwent R2 resections for pancreatic ductal adenocarcinoma (group B)

Stage		PDAC location	Arteryinvolved	ChT	Distant mets (mo)	Survival (mo)
cT3NxM0	pT4N1M0	Head	SMA	+	7	10
cT3NxM0	pT4N1M0	Body	SMA	-	3	6
cT3N1M0	pT4N1M0	Head	SMA	+	NA	11
cT3NxM0	pT4N1M0	Head	SMA	+	8	12
cT3N1M0	pT4N1M0	Head	SMA	+	7	11
cT3NxM0	pT3N1M0	Head	SMA	+	NA	9
cT3NxM0	pT4N0M0	Head	SMA	-	NA	9
cT3NxM0	pT4N1M0	Head	SMA	+	6	8

SMA: Superior mesenteric artery; PDAC: Pancreatic ductal adenocarcinoma; NA: Not available; СhT: Chemotherapy.

Table 4 The characteristics of patients who underwent bypass procedures for locally advanced pancreatic ductal adenocarcinoma (group C)

Stage	PDAC location	Artery involved	ChT	DFS (mo)	Survival (mo)
сT4N1M0	Head	SMA and CA	-	3	4
сT4NхM0	Head	SMA	-	NA	7
сT4NхM0	Head	SMA	+	4	7
сT4NхM0	Head	SMA	+	4	6,5
сT4NхM0	Head	SMA	+	NA	6
сT4N1M0	Body	SMA and CA	+	2	5
сT4NхM0	Total	SMA and CA	-	NA	4
сT4NхM0	Head	SMA	+	5	7
сT4NхM0	Head	SMA	+	5	9
сT4N1M0	Head	SMA and CA	+	NA	6
pT4N1M0	Body	SMA and CA	-	NA	6
pT4N1M0	Head	SMA	+	4	8

СhT: Chemotherapy; SMA: Superior mesenteric artery; CA: Celiac artery; GDA: Gastroduodenal artery; LHA: Left hepatc artery; CHA: Common hepatic artery; rRHA: Replaced right hepatic artery; DFS: Disease-free survival.

Table 5 The perioperative characteristics in groups

ME(25%-75%)	R0/R1 resection (n = 11)	R2 resection(n = 8)	Bypass(n = 12)
Operation time, min	570 (470-630)	540 (390-600)	Ne
Blood loss, mL	700 (450-1500)	1000 (600-1500)	Ne
ICU, d	2 (2-3)	3 (2-8)	Ne
Postoperative hospital stay, d	16 (13-26)	13 (12-19)	12 (11-17)

Table 6 The postoperative complications in groups (according to Clavien-Dindo classification)

	R0/R1 resecti-on (n = 11)	R2 resect-ion (n = 8)	Bypass(n = 12)
Grade 2	3	2	3
Lymphorrhea	3	2	-
Diarrhea	2	-	-
Delayed gastric emptying	-	-	3
Grade 3а
Pancreatic fistula1	3 (grade В)	1 (grade B)	-

¹According to ISGPF classification.

Table 7 The celiac trunk accuracy for assessment of arterial invasion in pancreatic cancer

Reference	n	Sensitivity	Specificity	PPV	NPV
Soriano et al[14]	62	67%	94%	89%	80%
Li et al[47]	54	79%	99%	-	-
House et al[48]	115	86% SMA, 87% CA	97% SMA, 99% CA	83% SMA ,93% CA	98% SMA, CA
Squillaci et al[52]	50	97%	100%	100%	95%
Gress et al[53]	151	15%	100%	100%	60%
Buchs et al[57]	153	54.5%	91.2%	66.7%	86.1%
Tellez-Avila et al[59]	50	66.7%	90%	60%	92.3%
Pietrabissa et al[63]	50	82%	53%	-	-

SMA: Superior mesenteric artery; CA: Celiac artery; PPV: positive predictive value; NPV: Negative predictive value.