A tumour score with multidetector spiral CT for venous infiltration in pancreatic cancer: influence on borderline resectable

Author(s):  
Tiziana Marinelli ◽  
Antonella Filippone ◽  
Francesca Tavano ◽  
Andrea Fontana ◽  
Fabio Pellegrini ◽  
...  
Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 978
Author(s):  
Nicolae Bacalbasa ◽  
Irina Balescu ◽  
Mihai Dimitriu ◽  
Cristian Balalau ◽  
Florentina Furtunescu ◽  
...  

Background: pancreatic cancer is one of the most lethal malignancies and a leading cause of cancer-related death worldwide. The only chance to improve the long-term outcomes of patients with pancreatic cancer is surgery with radical intent. Methods: in the present paper, we aim to describe a case series of 9 patients submitted to radical surgery for borderline resectable pancreatic cancer. Results: in all cases, negative resection margins were achieved. The types of venous resection consisted of tangential portal vein resection in four cases, circumferential portal vein resection with direct reanastomosis in one case and circumferential resection with graft placement in another four cases; postoperatively, one patient developed a vascular surgery-related complication consisting of graft thrombosis and thus necessitated prolonged anticoagulant therapy. Conclusions: extended venous resections can be a safe and efficient way to maximize the benefits of radical surgery in locally advanced, borderline resectable pancreatic cancer.


2020 ◽  
Vol 7 (4) ◽  
pp. 201-203
Author(s):  
Hans-Rudolf Raab

<b>Background:</b> One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. <b>Methods:</b> Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. <b>Results:</b> One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P &#x3c; 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p &#x3c; 0.05). <b>Conclusion:</b> Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. <b>Trial registration:</b> EudraCT: 2009–014476–21 (2013–02–22) and NCT01827553 (2013–04–09).


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