title: Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care.
abstract: Purpose To test the hypothesis that patients with pancreatic adenocarcinoma who otherwise are viewed to have resectable disease but have preoperative findings of extrapancreatic perineural invasion (EPNI) and/or duodenal invasion at multidetector computed tomography (CT) have reduced postoperative survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). Materials and Methods This study was approved by the institutional review board and complied with HIPAA. The authors retrospectively evaluated 76 consecutive patients with PDAC who underwent preoperative multidetector CT and subsequent pancreaticoduodenectomy. Two radiologists blinded to surgical pathology results and clinical outcome evaluated multidetector CT images for evidence of EPNI and duodenal invasion; discrepancies were resolved by consensus. Also determined for each patient were resected lymph node status, tumor size, surgical margin status, time to progression, and time to death. Data were assessed with the Goodman-Kruskal gamma for correlations among indicators and the log-rank test, Kaplan-Meier estimates, and multivariate Cox proportional hazards regression for survival analysis. Results In univariate analysis, duodenal invasion and/or EPNI on preoperativemultidetector CT images was associated with significantly decreased progression-free survival (P < .0001) and overall survival (P = .0013), and the clinical indicators (lymph node status, tumor size, and surgical margin status) as well as duodenal invasion and/or EPNI showed correlation with each other. In multivariate regression that included multidetector CT findings as well as the three traditional clinical indicators, only duodenal invasion and/or EPNI showed significant independent association with reduction in both modes of survival (P < .0001 and P = .014, respectively). Interobserver agreement was substantial with respect to EPNI and duodenal invasion (κ = 0.691 and 0.682, respectively). Conclusion Patients with evidence of EPNI and/or duodenal invasion on preoperative multidetector CT images have significantly reduced survival after pancreaticoduodenectomy for PDAC.©RSNA, 2016.
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Chang
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: Bhavik N
authors.initials: BN
authors.lastname: Patel
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: Michael A
authors.initials: MA
authors.lastname: DiMaio
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: Jarrett
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: Juergen K
authors.initials: JK
authors.lastname: Willmann
authors.affiliation: From the Departments of Radiology (S.T.C., R.B.J., B.N.P., J.R., J.K.W., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305-5105; and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (E.W.O.).
authors.forename: Eric W
authors.initials: EW
authors.lastname: Olcott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D010524:Peripheral Nervous System Neoplasms / Q000401:mortality / Q000473:pathology*; D011300:Preoperative Care / Q000379:methods