Endoscopic ultrasound and computed tomography predictors of pancreatic cancer resectability.
BACKGROUND
This study investigates the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to predict a margin negative (R0) resection and the need for venous resection in patients undergoing pancreaticoduodenectomy (PD).


METHODS
Patients with pancreatic head adenocarcinoma undergoing surgery with intent to resect during the last 5 years were identified. EUS and CT data on vascular involvement were collected. Preoperative imaging was compared to intraoperative findings and final pathology. Contingency table analysis using Fisher's exact test identified imaging features of EUS and CT associated with unresectability and positive margins.


RESULTS
Seventy-six patients met study criteria. Forty-seven (62%) underwent potentially curative PD. The R0 resection rate was 70%. There were 16 unresectable patients because of locally advanced disease. Venous involvement>180 degrees and arterial involvement>90 degrees by CT had 100% positive predictive value for failure to achieve R0 resection (p<.01). If patients with prestudy biliary stents were excluded, EUS venous abutment or invasion also predicted R0 failure (p=.02). Combined but not individual EUS and CT findings were predictive of need for vein resection.


CONCLUSIONS
Pancreas protocol CT imaging appears to be a better predictor of resectability compared to EUS. EUS accuracy is affected by the presence of biliary stents.
Bao
Philip Q
PQ
Department of Surgery, Vanderbilt University Medical Center, D-4314 MCN, 1161 21st Ave, Nashville, TN 37232, USA. philip.bao@vanderbilt.edu
Johnson
J Chad
JC
Lindsey
Elizabeth H
EH
Schwartz
David A
DA
Arildsen
Ron C
RC
Grzeszczak
Ewa
E
Parikh
Alexander A
AA
Merchant
Nipun B
NB
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*