Correlation of survival length after pancreaticoduodenectomy for pancreatic head adenocarcinoma depending on tumor characteristics detected by means of computed tomography and resection margins status

Abstract

Pancreatic carcinoma is an aggressive tumor with a grim prognosis. Accurate staging is essential for indicating surgery in patients with borderline resectable tumors. This paper examines the correlation between pre-operation characteristics of tumors found on CT, infiltration of individual resection margins as confirmed by a pathologist, and the survival of patients with resectable pancreatic head ductal adenocarcinoma. This prospective cohort study involved patients operated on for pancreatic head adenocarcinoma, which was clearly resectable based on the staging CT and intraoperative observation between 2011-2014. Only patients without postoperative complications who underwent adjuvant chemotherapy were analyzed. Seventy-nine patients were assessed, of which 16 (20.3%) had R0 resection and 63 (79.7%) had R1 resection. Patients with R1 results had up to 2.7 times higher risk of death than patients with R0 resection. We found a trend towards shorter survival associated with a closer relationship of the tumor to the superior mesenteric vein/portal vein (SMV/PV) wall in the preoperation CT examination. Patients with a tumor interface between the vein wall of up to 180° circumference had up to 1.97 times higher risk of death than patients without (p = 0.131). The results of our work confirmed that in our center, even surgically treated, clearly resectable pancreatic head tumors still have a high occurrence of positive surgical margins (R1 resection) and that tumors with R1 resection had statistically significantly reduced survival compared to R0 resection. A trend for shorter overall survival was found after tumor resection depending on the increasing interface between the tumor and the SMV/PV wall, but this result was not statistically significant.

Effectiveness of computed tomography-guided nasotracheal intubation procedure on predicting tube advancement difficulty and preventing epistaxis: a prospective case-control study

“…Besides, CT is used for surgical planning in the preoperative period and surgical guidance in the intraoperative period. [5][6][7] The internal nasal valve (INV) is the narrowest area of the nasal cavity. 8 Anatomically, the INV is located roughly 1.3cm from nares.…”

Effectiveness of Computed Tomography-Guided Nasotracheal Intubation Procedure on Predicting Tube Advancement Difficulty and Preventing Epistaxis: A Prospective Case-control Study

“…CT technique is among the most important of those devices. CT is used for surgical planning in the preoperative period and surgical guidance in the intraoperative period [5][6][7]. The internal nasal valve (INV) is the narrowest area of a nasal cavity [8].…”