Purpose
Pancreatic carcinoma is the 4th most common cause of cancer related death worldwide and one of the most aggressive human tumors.
Despite improved quality of surgery,
the prognosis of patients with pancreatic cancer is still dismal.
At the moment of diagnosis,
in fact,
only 10% of neoplasms are confined to the gland,
while 40% are locally advanced and 50% show distant metastases.
Surgical resection still represents the best therapeutic approach but only 20–25% of patients can benefit from it with a median survival after surgery...
Methods and Materials
We included 54 patients with locally-advanced pancreatic adenocarcinoma submitted to surgery with vascular resection.
All the exams were performed by a multidetector CT (Light Speed Plus,
GE Medical System,
Milwaukee USA or Light Speed VCT,
GE Medical System,
Milwaukee USA); the study was done after gastroduodenal hyperdistension,
obtained by oral administration of 750/1000 mL of water and by pharmacological hypotonization (Buscopan® o GlucaGen®),
in order to improve the visualization of the relationships between the gastric wall and pancreatic body and between the duodenal wall and...
Results
All cases were confirmed at histology as ductal adenocarcinoma of the pancreas.
Resection margin with microinfiltration (R+) was present in 11 cases (18,5%) of whom 9 localized at the SMA margin and 2 at the pancreatic resection margin.
In 37 patients the lesion was located in the pancreas head/uncinate process and in 8 patient in the pancreatic body,
with a lesion dimension ranging between 15mm and 60mm.
CT examination considered 67 vessels (42 veins and 25 artery) as infiltrated and 43 vessels (12 veins and...
Conclusion
The high mortality rate from cancer recurrence makes difficult the intraoperative distinction between curative and palliative resection.
Nonetheless,
some patients do benefit from resection,
especially if a margin negative resection can be accomplished.
Particularly,
vascular resection is justified on the basis of the intrinsic difficulty in differentiating preoperatively between inflammatory and tumoral adhesions.
MDCT represents an accurate technique that can help in identifying borderline resectable patients that can benefit from therapeutic surgery or patients that need neo-adjuvant chemotherapy.
Moreover each parameter of local staging and...
References
Seiki M,
Katsusuke S.
Pancreatic Cancer in Japan.
Pancreas 2004; Vol 28,
number 3.
Boggi U,
Del Chiaro M et al.
Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer.
J.
Surg.
2009; 146(5);869-81.
Evans D et al.
Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement.
Ann Surg Oncol 2009; 16:1736-1744.
Mazzeo S,
Cappelli C et al.
Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT,
intraoperative findings and histopatology.
Abdom...
Personal Information
Dr.
Carla Cappelli
Diagnostic and Interventional Radiology
Department of Oncology,
Transplants and Advanced Technologies in Medicine
Via Paradisa 2,
56124 (Pisa)
050/997311 050/995551
[email protected]
Dr.
Andrea Di Giambattista
Diagnostic and Interventional Radiology
Department of Oncology,
Transplants and Advanced Technologies in Medicine
Via Paradisa 2,
56124 (Pisa)
050/997311 050/995551
[email protected]