Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms.
A prospective diagnostic study was designed to determine the ability of thin-section contrast-enhanced computed tomography (CT) to predict the resectability of malignant neoplasms of the pancreatic head. Patients with a presumed resectable pancreatic neoplasm referred during a 21-month period were studied with abdominal CT performed at 1.5-mm section thickness and 5-mm slice interval during the bolus phase of intravenous contrast enhancement. CT criteria for resectability included the absence of extrapancreatic disease, no evidence of arterial encasement, and a patent superior mesenteric-portal venous confluence. Of 145 patients evaluated, 42 were considered to have resectable tumors by CT criteria, and 37 (88%) underwent potentially curative pancreaticoduodenectomy. Six patients were found to have a microscopically positive retroperitoneal resection margin; no patient had a grossly positive resection margin. Five (12%) of 42 patients were found at laparotomy to have unresectable, locally advanced or metastatic tumors. Thin-section contrast-enhanced CT is an essential component of the preoperative evaluation for pancreaticoduodenectomy and can prevent needles laparotomy in most patients with locally advanced or metastatic disease.
Fuhrman
G M
GM
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Charnsangavej
C
C
Abbruzzese
J L
JL
Cleary
K R
KR
Martin
R G
RG
Fenoglio
C J
CJ
Evans
D B
DB
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D018273:Carcinoma, Islet Cell / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D007472:Iohexol