title: The role of selective visceral angiography in the management of pancreatic and periampullary cancer.
abstract: A prospective study was undertaken to evaluate selective visceral angiography (SVA) in the management of patients with pancreatic and periampullary cancer. Over a 30-month period 52 patients with potentially resectable pancreatic or periampullary cancer underwent SVA; 4 patients had obvious angiographic evidence of widely disseminated disease and were not subjected to laparotomy while 2 further patients were eventually considered too frail for resection. The remaining 46 patients (median age 58 years, range 37-73 years, males 26, females 20) had no evidence of disseminated disease on ultrasonography and/or CT scanning and had both SVA and surgery and form the basis of this study. Vascular anomalies were detected in 16/46 (35%) patients. Hepatic metastases were wrongly diagnosed by angiography in 7 out of 9 patients (77%). SVA correctly predicted resectability or irresectability in 28/46 patients (overall predictive value 61%). Of the 27 patients who proved to have irresectable disease at operation, 11 were correctly identified by SVA (sensitivity 41%). Of the 13 patients reported to have irresectable disease, 2 underwent resection (false-positive rate 15%). Of the 33 patients reported to have resectable disease, 16 were irresectable (false-negative rate 48%). Overall there was a poor relationship between resectability and the angiographic features. On the basis of these data, SVA cannot be considered a sufficiently accurate means of assessing resectability. Its use for this purpose in patients with pancreatic and periampullary cancer is not justified.
authors.affiliation: University Department of Surgery, Royal Infirmary of Edinburgh, Scotland.
authors.forename: M
authors.initials: M
authors.lastname: Murugiah
authors.forename: J A
authors.initials: JA
authors.lastname: Windsor
authors.forename: D N
authors.initials: DN
authors.lastname: Redhead
authors.forename: J S
authors.initials: JS
authors.lastname: O'Neill
authors.forename: B
authors.initials: B
authors.lastname: Suc
authors.forename: O J
authors.initials: OJ
authors.lastname: Garden
authors.forename: D C
authors.initials: DC
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D000792:Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D014781:Viscera / Q000000981:diagnostic imaging