title: Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability.
abstract: OBJECTIVE
  To inquire into a question of an overestimation of arterial involvement in patients with pancreatic cancer (PC).
  
  
  METHODS
  Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with celiac artery (CA) excision; and 28 palliations for PC. The survival of 11 patients with controversial computed tomography (CT) and endoscopic ultrasound data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (true-positive CT results, Group C).
  
  
  RESULTS
  In all of the cases in group A, operative exploration revealed no arterial invasion, which was predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 mo. One-year survival was not attained in groups B and C, with a significant difference in survival (P a-b = 0.0029, P b-c = 0.003).
  
  
  CONCLUSIONS
  Arterial encasement on CT does not necessarily indicate arterial invasion. Whenever PC is considered unresectable, endoUS should be used. In patients with controversial CT an EUS data for peripancreatic arteries involvement radical resection might be possible, providing survival benefits as compared to R2- resections or palliative surgery.
authors.affiliation: Vyacheslav I Egorov, Department of Surgical Oncology, Ostroumov 14 City Hospital, Sechenov First State Medical University, 119048 Moscow, Russia.
authors.forename: Vyacheslav I
authors.initials: VI
authors.lastname: Egorov
authors.forename: Roman V
authors.initials: RV
authors.lastname: Petrov
authors.forename: Elena N
authors.initials: EN
authors.lastname: Solodinina
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Karmazanovsky
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Starostina
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Kuruschkina
keywords: Arteries; Cancer; Computed tomography; Distal pancreatectomy; Endoscopic ultrasound; Management; Pancreas; Pancreaticoduodenectomy; Resectability; Vascular invasion