title: Assessment of the interface between retroperitoneal fat infiltration of pancreatic ductal carcinoma and the major artery by multidetector-row computed tomography: surgical outcomes and correlation with histopathological extension.
abstract: BACKGROUND
  Precise assessment of retroperitoneal invasion is clinically important to allow the achievement of negative margin resections.
  
  
  METHODS
  The clinical records of 132 patients who underwent macroscopic curative pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas between 2004 and 2008 were retrospectively examined. The clinicopathological factors, including retroperitoneal fat infiltration classified into four groups by multidetector-row computed tomography (MDCT), were analyzed. The relationship between the grade of retroperitoneal fat infiltration and surgical outcomes, as well as various histopathological factors, was also investigated.
  
  
  RESULTS
  The 5 year survival rate was 55.6 % for grade 0 infiltration (n = 8), 38.7 % for grade 1 (n = 54), 16.4 % for grade 2 (n = 49), and 0 % for grade 3 (n = 21). There were significant differences in survival in each group. Extrapancreatic nerve invasion and the surgical margin status were significantly associated with retroperitoneal fat infiltration demonstrated on MDCT. According to the grading classification among the 43 patients with pathological portal vein invasion, the 5 year survival rate was 45.9 % for patients with grade 1, which was significantly better survival that those with grade 2 (P = 0.007).
  
  
  CONCLUSIONS
  The grading criteria for retroperitoneal fat infiltration may be useful as a predictor of survival after pancreaticoduodenectomy for pancreatic head carcinoma. Pancreaticoduodenectomy with portal vein resection could provide favorable survival in patients with grade 1 retroperitoneal fat infiltration, even if histopathological portal vein invasion is present.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Central Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. yamayu-1@koto.kpu-m.ac.jp
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Keitaro
authors.initials: K
authors.lastname: Sofue
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shibamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hiraoka
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery