Predicting resectability of periampullary cancer with three-dimensional computed tomography.
The radiographic assessment of extent of tumor burden and local vascular invasion appears to be enhanced with three-dimensional computed tomography (3D-CT). The purpose of this study was to evaluate the impact of preoperative 3D-CT in determining the resectability of patients with periampullary tumors. Intraoperative findings from exploratory laparotomy were gathered prospectively from 140 patients who were thought to have periampullary tumors and were deemed resectable after undergoing preoperative 3D-CT imaging. CT findings were compared to intraoperative findings, and the accuracy of 3D-CT in predicting tumor resectability and, ultimately, the likelihood of obtaining a margin-negative resection were assessed. Of the 140 patients who were thought to have resectable periampullary tumors after preoperative 3D-CT, 115 (82%) were subsequently determined to have periampullary cancer. The remaining 25 patients had benign disease. Among the patients with periampullary cancer, the extent of local tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D-CT in 93% of the patients. 3D-CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels. Preoperative 3D-CT accurately predicted periampullary cancer resectability and a margin-negative resection in 98% and 86% of patients, respectively. For patients with pancreatic adenocarcinoma (n=85), preoperative 3D-CT resulted in a resectability rate and a margin-negative resection rate of 79% and 73%, respectively. The ability of 3D-CT to predict a margin-negative resection for periampullary cancer, including pancreatic adenocarcinoma, relies on its enhanced assessment of the extent of local tumor burden and involvement of the mesenteric vascular anatomy.
House
Michael G
MG
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Yeo
Charles J
CJ
Cameron
John L
JL
Campbell
Kurt A
KA
Schulick
Richard D
RD
Leach
Steven D
SD
Hruban
Ralph H
RH
Horton
Karen M
KM
Fishman
Elliot K
EK
Lillemoe
Keith D
KD
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D014670:Ampulla of Vater; D002445:Celiac Artery; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*