Original Article
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World J Gastrointest Surg. Apr 27, 2013; 5(4): 83-96
Published online Apr 27, 2013. doi: 10.4240/wjgs.v5.i4.83
Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability
Vyacheslav I Egorov, Roman V Petrov, Elena N Solodinina, Gregory G Karmazanovsky, Natalia S Starostina, Natalia A Kuruschkina
Vyacheslav I Egorov, Department of Surgical Oncology, Ostroumov 14th City Hospital, Sechenov First State Medical University, 119048 Moscow, Russia
Roman V Petrov, Department of Surgical Oncology, Ostroumov 14th City Hospital, 119048 Moscow, Russia
Elena N Solodinina, Natalia A Kuruschkina, Department of Endoscopy, Vishnevsky Institute of Surgery, 117997 Moscow, Russia
Gregory G Karmazanovsky, Natalia S Starostina, Department of Radiology, Vishnevsky Institute of Surgery, 117997 Moscow, Russia
Author contributions: Egorov VI contributed to concept and design of the paper; Egorov VI, Petrov RV and Starostina NS contributed to surgery and follow-up; Karmazanovsky GG and Starostina NS contributed to imaging; Solodinina EN and Kuruschkina NA contributed to endoscopy and endoUS; all the authors contributed to data acquisition/interpretation, literature research, drafting the manuscript, revision and final version approval.
Correspondence to: Dr. Vyacheslav I Egorov, Department of Surgical Oncology, Ostroumov 14th City Hospital, Sechenov First State Medical University, 2, Building 2, Bolshaya Pirogovskaya Str., 119048 Moscow, Russia. v.egorov61@gmail.com
Telephone: +7-926-7359511 Fax: +7-926-7359511
Received: November 22, 2012
Revised: February 9, 2013
Accepted: February 28, 2013
Published online: April 27, 2013
Processing time: 152 Days and 21.3 Hours
Abstract

AIM: To inquire into a question of an overestimation of arterial involvement in patients with pancreatic cancer (PC).

METHODS: Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with celiac artery (CA) excision; and 28 palliations for PC. The survival of 11 patients with controversial computed tomography (CT) and endoscopic ultrasound data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (true-positive CT results, Group C).

RESULTS: In all of the cases in group A, operative exploration revealed no arterial invasion, which was predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 mo. One-year survival was not attained in groups B and C, with a significant difference in survival (Pa-b = 0.0029, Pb-c = 0.003).

CONCLUSION: Arterial encasement on CT does not necessarily indicate arterial invasion. Whenever PC is considered unresectable, endoUS should be used. In patients with controversial CT an EUS data for peripancreatic arteries involvement radical resection might be possible, providing survival benefits as compared to R2- resections or palliative surgery.

Keywords: Vascular invasion; Cancer; Pancreas; Management; Pancreaticoduodenectomy; Distal pancreatectomy; Computed tomography; Endoscopic ultrasound; Arteries; Resectability

Core Tip: Pancreatic cancer remains one of the most aggressive neoplastic processes, and the methods to manage it are constantly evolving. Resection remains the only potential cure for pancreatic cancer, and it can prolong survival in patients compared to those who do not undergo resection. However, only a minority of patients are candidates for surgery at diagnosis, and only a minority of patients who undergo surgery survive beyond 5 years. The most important cause of an inacurate assessment of resectability is underestimation of vascular invasion. This study attempted to address the other side of the problem: overestimation of arterial involvement in patients with pancreatic cancer.