Evaluation of curved planar reformation images along the main pancreatic duct for preoperative staging of pancreatic head cancer

Abstract Background: To compare imaging features and analyze prognostic differences among different groups with pancreatic head cancer invading the peripheral nerve plexus. Methods: We reviewed preoperative multislice spiral CT (MSCT) images, complete surgical records, and postoperative pathological results of 93 patients with pancreatic head cancer and peripheral nerve invasion. Two radiologists who were unaware of surgical and pathological results evaluated the MSCT images to determine peripheral nerve invasion of pancreatic head cancer. A pathologist who was unaware of the imaging findings grouped the patients based on surgical records and pathological findings. Pancreatic head cancer invasion of the anterior neural pathway was assigned to group A and invasion of pancreatic plexus 1, pancreatic plexus 2, and root of the mesenteric pathway to group B. Both groups were evaluated for peripheral nerve invasion, tumor size, dilatation of the common bile duct/main pancreatic duct, duodenal invasion, and prognosis of pancreatic head cancer.Results: A mass- and strand-like pattern or coarse reticular pattern was frequently observed when two groups of pancreatic head cancer invaded the peripheral nerve plexus. Intergroup differences in tumor size and common bile duct/main pancreatic duct dilatation were insignificant. The duodenal invasion rate was higher in group A than in group B; however, the intergroup difference was insignificant. The prognosis was poorer for group A than for group B.Conclusions: Although the intergroup differences in radiographic findings were not significant, the prognosis was poorer for group A than for group B.

Download Full-text

Successful resection of pancreatic head cancer in a patient with circumportal pancreas: a case report with technical consideration

Innovative Surgical Sciences ◽

10.1515/iss-2017-0003 ◽

2017 ◽

Vol 2 (1) ◽

pp. 33-37 ◽

Cited By ~ 1

Author(s):

Hiroshi Kawamoto ◽

Takahisa Fujikawa ◽

Akira Tanaka

Keyword(s):

Main Pancreatic Duct ◽

Pancreatic Head ◽

Technical Approach ◽

Pancreatic Anastomosis ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Dorsal Edge ◽

Head Of The Pancreas ◽

Circumportal Pancreas ◽

Ventral Edge

AbstractWe report a case of pancreaticoduodenectomy for pancreatic head cancer with circumportal pancreas (CP). A 76-year-old woman was referred to our hospital with complaint of generalized pruritus. Dynamic computed tomography (CT) revealed an unenhanced mass at the head of the pancreas and a dilated main pancreatic duct (MPD) behind the superior mesenteric vein (SMV). She was diagnosed with pancreatic head cancer with CP and underwent subtotal stomach-preserving pancreaticoduodenectomy (SSpPD). The pancreas was transected both beneath and above the SMV, and the dominant dorsal edge of the pancreas was mobilized and anastomosed with the gut, whereas the ventral edge was closed by suture and attached to the gut. The postoperative course was uneventful without the occurrence of pancreatic fistula or bleeding. CP is a rare anomaly in which a portal vein (PV) is encircled by the annular pancreatic parenchyma. CP is usually asymptomatic without any significant comorbidity but may become a surgical hazard when pancreaticoduodenectomy is performed. We report our successfully treated case, with special references to the technical approach for pancreatic anastomosis.

Download Full-text

Clinical Utility of Bile Duct Axis Deviation for Differential Diagnosis Between Pancreatic Head Cancer and Bile Duct Cancer

The American Surgeon ◽

10.1177/0003134820954851 ◽

2020 ◽

pp. 000313482095485

Author(s):

Toru Shirakawa ◽

Yoshito Tomimaru ◽

Shiro Hayashi ◽

Kozo Noguchi ◽

Tsutomu Nishida ◽

...

Keyword(s):

Differential Diagnosis ◽

Bile Duct ◽

Bile Duct Cancer ◽

Main Pancreatic Duct ◽

Pancreatic Head ◽

Axis Deviation ◽

Clinical Factors ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Duct Cancer

Backgrounds Differential diagnosis between pancreatic head cancer (PHC) and intrapancreatic bile duct cancer (BDC) is important, but no clinical standard has been established. Here we examine the diagnostic utility of bile duct axis deviation and other clinical factors for this differential diagnosis. Methods This study enrolled patients who underwent pancreaticoduodenectomy for PHC or BDC at our center between 2009 and 2016. PHCs in groove or uncinate portions were excluded from analysis. From contrast-enhanced computed tomography images, the bile duct angle (BDA) was measured using three points: the junction of intrahepatic bile ducts, upper pancreatic edge, and Vater papilla. Logistic regression was performed to evaluate the diagnostic performance of BDA and other clinical factors for differential diagnosis. Results During the study period, 22 PHCs and 31 BDCs were resected. The combination of BDA ≤ 130°, main pancreatic duct diameter ≥ 4.3 mm, and absence of jaundice predicted PHC rather than BDC with an area under the curve of the receiver-operator characteristics curve of .856 (95% confidence interval, .766-.947). Conclusion Clinical findings of larger bile duct axis deviation, main pancreatic duct dilation, and the absence of jaundice may be useful for distinguishing PHC from BDC.

Download Full-text