Faculty Collaboration Database

Radiographic tumor-vein interface as a predictor of intraoperative, pathologic, and oncologic outcomes in resectable and borderline resectable pancreatic cancer. J Gastrointest Surg 2014 Feb;18(2):269-78; discussion 278

Date

10/17/2013

Pubmed ID

24129826

Pubmed Central ID

PMC4016045

DOI

10.1007/s11605-013-2374-3

Scopus ID

2-s2.0-84893325927 (requires institutional sign-in at Scopus site)   96 Citations

Abstract

BACKGROUND: Venous resection may be required to achieve complete resection of pancreatic cancers. We assessed the ability of radiographic criteria to predict the need for superior mesenteric-portal vein (SMV-PV) resection and the presence of histologic vein invasion.

METHODS: All patients who underwent pancreaticoduodenectomy from 2004 to 2011 at the authors' institution were identified. Preoperative pancreatic protocol CT images were re-reviewed to characterize the extent of tumor-vein circumferential interface (TVI) as demonstrating no interface, ≤ 180° of vessel circumference, >180° of vessel circumference, or occlusion. Findings were correlated with the need for venous resection, histologic venous invasion, and survival.

RESULTS: A total of 254 patients underwent pancreaticoduodenectomy and met inclusion criteria; 98 (39.6 %) required SMV-PV resection. In our cohort, 76.4 % of patients received neoadjuvant chemoradiation. The TVI classification system predicted with fair accuracy both the need for SMV-PV resection at the time of surgery and histologic invasion of the vein. In particular, 89.5 % of patients with TVI > 180° or occlusion required SMV-PV resection. Of those, 82.4 % had documented histologic SMV-PV invasion. TVI ≤ 180° was associated with favorable overall survival compared to a greater circumferential interface.

CONCLUSIONS: A tomographic classification of the tumor-SMV-PV interface can predict the need for venous resection, pathologic venous involvement, and survival. To assist in treatment planning, a standardized assessment of this anatomic relationship should be routinely performed.

Author List

Tran Cao HS, Balachandran A, Wang H, Nogueras-González GM, Bailey CE, Lee JE, Pisters PW, Evans DB, Varadhachary G, Crane CH, Aloia TA, Vauthey JN, Fleming JB, Katz MH

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Aged
Chemoradiotherapy, Adjuvant
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Male
Mesenteric Veins
Middle Aged
Neoadjuvant Therapy
Neoplasm Invasiveness
Pancreatic Neoplasms
Pancreaticoduodenectomy
Portal Vein
Predictive Value of Tests
Retrospective Studies
Survival Rate
Tomography, X-Ray Computed