Clinical significance of intraportal endovascular ultrasonography for the diagnosis of extrapancreatic nerve plexus invasion by pancreatic carcinoma.
OBJECTIVE
The extrapancreatic nerve plexus (PL) invasion is a common feature of pancreatic cancer and affects the outcome of the patients after surgical resection. IPEUS with high-resolution probes can visualize the PL invasion with high overall accuracy rate. The aim of this study is to evaluate the clinical significance of the PL invasion diagnosed intraoperatively by intraportal endovascular ultrasonography (IPEUS).


METHODS
IPEUS was performed in 64 patients who underwent the pancreatic resection. Several clinicopathological factors were studied in patients with or without PL invasion.


RESULTS
There were 18 cases in which PL invasion was confirmed pathologically. IPEUS showed 94% sensitivity, 98% specificity and 97% accuracy for the diagnosis of the PL invasion with the false-positive rate of 5.6%. The 1-, 2- and 3-year survival in 18 patients with PL invasion was 30, 6 and 0% in comparison to 52, 32 and 18% in those 46 patients without PL invasion and the difference was statistically significant (p = 0.008). A significant correlation was found between PL invasion and the portal vein invasion, invasion of the margins or pTNM stage.


CONCLUSIONS
According to current results, the prognosis of the cases with PL invasion is very poor and indication for resection is doubtful. We conclude that the cases in which PL invasion is diagnosed by IPEUS are not indicated for extended resection and correct diagnosis of PL invasion is important not only to predict the outcome but also to decide the surgical procedure for obtaining negative margins while improving the quality of life after surgery.
Tezel
Ekmel
E
Department of Surgery II, Graduate School and Faculty of Medicine, University of Nagoya, Nagoya, Japan.
Kaneko
Tetsuya
T
Sugimoto
Hiroyuki
H
Takeda
Shin
S
Inoue
Soichiro
S
Nagasaka
Tetsuro
T
Nakao
Akimasa
A
D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*