Radiographic Tumor–Vein Interface as a Predictor of Intraoperative, Pathologic, and Oncologic Outcomes in Resectable and Borderline Resectable Pancreatic Cancer

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• 作者：Hop S. Tran Cao (1)
  Alpana Balachandran (2)
  Huamin Wang (3)
  Graciela M. Nogueras-González
  Christina E. Bailey (1)
  Jeffrey E. Lee (1)
  Peter W. T. Pisters (1)
  Douglas B. Evans (7)
  Gauri Varadhachary (5)
  Christopher H. Crane (6)
  Thomas A. Aloia (1)
  Jean-Nicolas Vauthey (1)
  Jason B. Fleming (1)
  Matthew H. G. Katz (1)
  
• 关键词：Pancreatic adenocarcinoma ; Borderline resectable ; Superior mesenteric vein ; Portal vein ; Computed tomography
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：18
• 期：2
• 页码：269-278
• 全文大小：562 KB
• 作者单位：Hop S. Tran Cao (1)
  Alpana Balachandran (2)
  Huamin Wang (3)
  Graciela M. Nogueras-González
  Christina E. Bailey (1)
  Jeffrey E. Lee (1)
  Peter W. T. Pisters (1)
  Douglas B. Evans (7)
  Gauri Varadhachary (5)
  Christopher H. Crane (6)
  Thomas A. Aloia (1)
  Jean-Nicolas Vauthey (1)
  Jason B. Fleming (1)
  Matthew H. G. Katz (1)
  
  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, FCT 17.6058, Houston, TX, 77230-1402, USA
  2. Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
  3. Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
  7. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
  5. Department of Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
  6. Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
  
• ISSN：1873-4626

文摘

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, ?80° 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 ?80° 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.