title: Escalating computed tomography angiogram (CTA) grade predicts unresectability and margin status for pancreaticobiliary neoplasms.
abstract: OBJECTIVE
  The Raptopoulos computed tomography (CT) grading system of pancreaticobiliary cancers was conceived to predict resectability based on tumour involvement of critical vasculature. The aim of the present study was to investigate the relationship between CT grade, resectability, margin status and survival after pancreatic resection.
  
  
  METHODS
  Patients with presumed pancreaticobiliary malignancy and a pancreas protocol computed tomography angiogram (CTA) who underwent attempted curative resection from October 2001 and August 2008 were identified. The relationship between radiographical involvement of critical vasculature, according to a five-point scale, and ultimate resectability, margin status and survival was assessed.
  
  
  RESULTS
  Overall, 276 (70.2%) out of 393 patients were resectable. The proportion of patients who were unresectable at laparotomy increased as CT grade escalated; 41/250 (16.4%) CT Grade 0, 16/55 (29.1%) CT Grade 1, 33/55 (60%) CT Grade 2, 27/33 CT Grade 3, P < 0.001. Local invasion or vascular involvement was the reason for unresectability in 14/41, 12/16, 23/33, 16/27 patients with CT Grade 0-3, respectively. A R0 resection was achieved in 84/131 patients with pancreatic adenocarcinoma and varied significantly by CT grade, P= 0.021. Significant predictors of survival were age (P < 0.0001), resectability (P < 0.0001) and diagnosis (P < 0.009).
  
  
  CONCLUSIONS
  Escalating Raptopoulos CT grade is correlated with increasing probability of unresectability and R1 resection.
authors.affiliation: Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. tkent@bidmc.harvard.edu
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: Vassilios
authors.initials: V
authors.lastname: Raptopoulos
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D001808:Blood Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality