Purpose
The salient indication of pancreatic cancer (PC) unresectability is the superior mesenteric (SMA) and celiac artery (CA) encasement,
signaling arterial invasion.
Computed tomography (CT) is the gold standard for PC resectability evaluation.
How to extract patients with Stage II pancreatic cancer (who benefit from radical surgery) from Stage III group in which they have to be included according to present regulations if we use only CT (and this is general practice) for diagnostics of arterial involvement.
Methods and Materials
The data from the preoperative CT and EUS reports on 163 patients consecutively operated on for ductal adenocarcinoma were compared with the findings at 51 standard,
58 extended,
17 total pancreatoduodenectomies (PDs),
9 distal resections with the CA excision (DPCA) and 28 palliative bypasses for PDAC between June 2005 and July 2012.
From all of these cases,
11 patients were found who had controversial data of CT and EUS in regard to peripancreatic arterial tumor invasion.
They all had CT signs of arterial involvement,
but...
Results
The diagnosis of ductal adenocarcinoma of the pancreas was histologically proven in all the cases.
In all the cases of group A the arteries involved on CT were considered intact at surgery (Fig.
1-13).
There were no difference between the groups for age and sex.
The tumor size was significantly greater in the bypass group (Тable 1),
although real tumor size in these patients could not be measured because tumors were not removed and were assessed at surgery only approximately.
An attempt of pancreaticodudenectomy or...
Conclusion
Arterial encasement on CT does not necessarily signify arterial invasion.
Whenever PC is considered unresectable endoUS should be used.
In selected cases,
radical resection may be possible and provide survival benefit
References
Guidelines for the management of patients with pancreatic cancer,
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(2005) Gut; 54 Suppl 5: v1-16
Exocrine and endocrine pancreas.
In: Edge SB,
Byrd DR,
Compton CC,
et al.,
eds.: AJCC Cancer Staging Manual.
7th ed.
New York,
NY: Springer,
2010,
pp 241-9.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).
Pancreatic Adenocarcinoma Version 2.
2012.
Fort Washington,
PA,
USA: National Comprehensive Cancer Network,
Inc (NCCN),
2012
Michalski CW,
Kleeff J,
Bachmann J,
Alkhatib J,
Erkan M,
Esposito I.
et al.
(2008)...