Keywords:
Pathology, Surgery, Computer Applications-Detection, diagnosis, Computer Applications-3D, CT-High Resolution, CT-Angiography, CT, Oncology, Abdomen
Authors:
O. Zakharova, G. Karmazanovsky; Moscow/RU
DOI:
10.1594/ecr2012/C-1198
Conclusion
Pancreatic cancer remains the fourth leading cause of cancer deaths.
It has an over-all 5-year survival rate of 4%,
while localized cancers have a survival rate of 17% [4].
About 15 to 20% of patients have resectable disease at the time of presentation [6].
Surgical resection offers the only chance for cure with reported 5-year survival rates of 8% to 21% [3].
Tumors are considered unresectable when metastatic disease or local vascular invasion is present.
The vessels most often involved are the celiac trunk,
the hepatic artery and the superior mesenteric artery [1,
5].
MDCT has been widely accepted as the imaging technique of choice for the staging of pancreatic adenocarcinoma.
Despite the advent of endoscopic ultrasound,
computed tomography remains a mainstay of preoperative assessment [2,
7,
12].
However,
a significant number of patients are still incorrectly diagnosed as having resectable tumor on MDCT only to be unresectable at surgery.
The number of patients undergoing unnecessary laparotomies may vary between 21% and 44% [5,
9,
10].
The purpose of our study is to evaluate the ability of multi-detector computed tomography (MDCT) to assess vascular involvement in patients with pancreatic cancer.
Based on our study MDCT alone has been shown too inaccurate for the evaluation of resectability,
particularly in defining artery invasion.
Patients with MDCT signs of major artery invasion (radiological absence of a fat plane between tumor and vessel,
wall irregularity,
vascular encasement >50%) turn out to have resectable tumors,
without vessel invasion at surgery.
Therefore it may be necessary to combine different diagnostic modalities or even include laparoscopic evaluation of vessel to tumor contact in the treatment algorithm of patients with suspected pancreatic cancer artery involvement.
Apparently,
surgical exploration with pathological examination remains the “gold standard” from the standpoint of vascular involvement for patients with pancreatic cancer.