TY - JOUR
T1 - Borderline respectable pancreatic tumors:
T2 - Is there a need for further refinement of this stage?
AU - Shrikhande, Shailesh V.
AU - Arya, Supreeta
AU - Barreto, Savio George
AU - Ingle, Sachin
AU - D'Souza, Melroy A.
AU - Hawaldar, Rohini
AU - Shukla, Parul J.
PY - 2011/6
Y1 - 2011/6
N2 - BACKGROUND: The ideal treatment of patients with borderline resectable pancreatic tumors (BRTs) needs to be established. Current protocols advise neoadjuvant chemo (radio) therapy, although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection. The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection, with or without vascular resection (VR), could be achieved. METHODS: Twelve patients with BRTs were identified. Tumor location, maximum degree of circumferential contact (CC), length of contact of the tumor with major vessels (LC), and luminal narrowing of vessels at the point of contact with the tumor (venous deformity, VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR. RESULTS: A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin. Four of the 10 patients required VR (40%). In 3 of the 4 patients whose tumors required VRs, CC was ≥grade III and VD was grade 2. LC did not influence the need for VR. CONCLUSIONS: It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging. Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients, thus avoiding any delay in curative resections in such patients.
AB - BACKGROUND: The ideal treatment of patients with borderline resectable pancreatic tumors (BRTs) needs to be established. Current protocols advise neoadjuvant chemo (radio) therapy, although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection. The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection, with or without vascular resection (VR), could be achieved. METHODS: Twelve patients with BRTs were identified. Tumor location, maximum degree of circumferential contact (CC), length of contact of the tumor with major vessels (LC), and luminal narrowing of vessels at the point of contact with the tumor (venous deformity, VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR. RESULTS: A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin. Four of the 10 patients required VR (40%). In 3 of the 4 patients whose tumors required VRs, CC was ≥grade III and VD was grade 2. LC did not influence the need for VR. CONCLUSIONS: It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging. Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients, thus avoiding any delay in curative resections in such patients.
KW - Pancreatic cancer
KW - Pancreatic head carcinoma
KW - Pancreatic neoplasms
KW - Resection
UR - http://www.scopus.com/inward/record.url?scp=79959300424&partnerID=8YFLogxK
U2 - 10.1016/S1499-3872(11)60053-2
DO - 10.1016/S1499-3872(11)60053-2
M3 - Article
C2 - 21669578
AN - SCOPUS:79959300424
SN - 1499-3872
VL - 10
SP - 319
EP - 324
JO - Hepatobiliary and Pancreatic Diseases International
JF - Hepatobiliary and Pancreatic Diseases International
IS - 3
ER -