title: Radiographic tumor-vein interface as a predictor of intraoperative, pathologic, and oncologic outcomes in resectable and borderline resectable pancreatic cancer.
abstract: BACKGROUND
  Venous resection may be required to achieve complete resection of pancreatic cancers. We assessed the ability of radiographic criteria to predict the need for superior mesenteric-portal vein (SMV-PV) resection and the presence of histologic vein invasion.
  
  
  METHODS
  All patients who underwent pancreaticoduodenectomy from 2004 to 2011 at the authors' institution were identified. Preoperative pancreatic protocol CT images were re-reviewed to characterize the extent of tumor-vein circumferential interface (TVI) as demonstrating no interface, ≤ 180° of vessel circumference, >180° of vessel circumference, or occlusion. Findings were correlated with the need for venous resection, histologic venous invasion, and survival.
  
  
  RESULTS
  A total of 254 patients underwent pancreaticoduodenectomy and met inclusion criteria; 98 (39.6 %) required SMV-PV resection. In our cohort, 76.4 % of patients received neoadjuvant chemoradiation. The TVI classification system predicted with fair accuracy both the need for SMV-PV resection at the time of surgery and histologic invasion of the vein. In particular, 89.5 % of patients with TVI > 180° or occlusion required SMV-PV resection. Of those, 82.4 % had documented histologic SMV-PV invasion. TVI ≤ 180° was associated with favorable overall survival compared to a greater circumferential interface.
  
  
  CONCLUSIONS
  A tomographic classification of the tumor-SMV-PV interface can predict the need for venous resection, pathologic venous involvement, and survival. To assist in treatment planning, a standardized assessment of this anatomic relationship should be routinely performed.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, FCT 17.6058, Houston, TX, 77230-1402, USA.
authors.forename: Hop S
authors.initials: HS
authors.lastname: Tran Cao
authors.forename: Alpana
authors.initials: A
authors.lastname: Balachandran
authors.forename: Huamin
authors.initials: H
authors.lastname: Wang
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Nogueras-González
authors.forename: Christina E
authors.initials: CE
authors.lastname: Bailey
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Gauri
authors.initials: G
authors.lastname: Varadhachary
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed