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KMID : 0870420050090010055
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2005 Volume.9 No. 1 p.55 ~ p.61
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Determination of Resectability for Pancreatic Head Cancer: Based on the Suspected Vascular Invasion in Abdominal Computed Tomography
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Han Sung-Sik
Kim Sun-Whe
Park Yong-Hyun
Park Yun-Chan
Jang Jin-Young
Choi Joon-Il
Choi Min-Gew
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Abstract
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Purpose: To determine the resectability of pancreatic head cancer by correlating the surgical findings with those of a suspected vascular invasion by abdominal computed tomography (CT).
Methods: The portal vein, superior mesenteric vein, celiac artery, common hepatic artery and superior mesenteric artery were investigated in 100 pancreatic cancer patients who underwent two-phase CT of the pancreas. The degree of vascular encasement, luminal narrowing and the length of the involved segment were analyzed in order to correlate the surgical results. The CT findings and associated unresectable causes were analyzed in those patients who underwent the non-operative treatment.
Results: A surgical correlation was available in 66 patients, whose 116 vessels were examined. Vascular encasement was categorized into 5 groups (0: none, 1: ≤90o, 2: 91～180o, 3: 181～270o, 4: 271～360o). If category 0, 1 and 2 was determined to be vascular invasion (-), the positive predictive value and negative predictive value were 91.7% and 80% in the veins, and 100% and 75.4% in the arteries. If category 0, 1, 2 and 3 in the vein were determined to be vascular invasion (-), the respective values were 100% and 75.4%. While all the arteries with narrowing were unresectable, some veins with narrowing less than 2/3 of the diameter were resectable. The mean length of the segment involved in the resectable veins was significantly shorter than that of the unresectable veins.
Conclusion: A non-operative treatment is recommended when vascular encasement exceeds 270o in the veins or 180o in the arteries, when the arteries show narrowing, or when the veins show narrowing more than 2/3 of the original diameter. A curative resection should be attempted when the vascular encasement reaches ＜180o and when the arterial narrowing is absent.
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KEYWORD
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Pancreas/Blood Supply, Pancreatic Neoplasm, Sensitivity and Specificity, Tomography, Computed, Portal Vein/Radiography
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