title: Preoperative diagnosis of portal vein invasion in pancreatic head cancer: appropriate indications for concomitant portal vein resection.
abstract: BACKGROUND
  The surgical indications for patients with pancreatic head cancer (PHC) with clinical portal vein (PV) invasion (cPV) remain controversial. The present study aimed to determine the ability of computed tomography (CT) to diagnose pathological PV involvement (pPV) in PHC.
  
  
  METHODS
  We evaluated the morphological features (length and circumference) and two sets of diagnostic criteria for cPV determined from preoperative CT findings of 112 consecutive patients who underwent pancreatoduodenectomy for PHC. This study is listed in the UMIN Clinical Trials Registry (UMIN-CTR; No: UMIN000016827).
  
  
  RESULTS
  Five patients were excluded because enhanced CT data were missing. Morphological features have low diagnostic ability for pPV. We diagnosed 67 patients with cPV based on our diagnostic criteria and those of Klauss, and 42 of them had pPV. The negative predictive values of these diagnostic criteria for pPV were satisfactory (>95%) and the positive predictive value was relatively low (61.2%). Postoperative survival could be predicted based on the cPV type.
  
  
  CONCLUSIONS
  An accurate diagnosis of pPV based on morphological features determined by preoperative CT is difficult. However, preoperative CT appears useful for selecting patients with PHC who could be candidates for pancreaticoduodenectomy with or without PV resection.
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Teramura
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. drnoji@med.hokudai.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Asano
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Kimitaka
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakanishi
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okamura
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Computed tomography; Pancreatic head cancer; Pathological invasion; Prediction; Surgical indication