Pancreatic Cancer CT: Prediction of Resectability according to NCCN Criteria

Abstract

To evaluate the diagnostic performance of CT in the determination of pancreatic cancer resectability according to the National Comprehensive Cancer Network (NCCN) criteria to predict R0 resection. Materials and Methods: Structured reports of pancreatic CT clinically prepared by board-certified abdominal radiologists from January 2014 to March 2017 were retrospectively reviewed to assess resectability (resectable, borderline resectable, or unresectable) according to NCCN criteria (version 1.2017) in 616 patients (369 men, 247 women; mean age, 63 years 6 10 [standard deviation]) with pancreatic cancer. Negative resection margin (R0) rates were assessed based on CT resectability status in patients who underwent upfront surgery. R0 resection-associated factors were identified by using logistic regression analysis. Results: In 371 patients who underwent surgery, R0 resection rates were 73% (171 of 235), 55% (57 of 104), and 16% (five of 32) for resectable, borderline resectable, and unresectable disease, respectively (P , .001). At multivariable analysis, tumor diameter larger than 4 cm (P , .001) and abutment to the portomesenteric vein (P , .001) were significantly associated with marginpositive resection in patients with resectable disease at CT. R0 resection rates were 80% (123 of 154) for resectable disease without portomesenteric vein abutment, 59% (48 of 81) for resectable disease with portomesenteric vein abutment, 83% (57 of 69) for resectable disease 2 cm or smaller, and 29% (five of 17) for tumors larger than 4 cm. Conclusion: CT resectability is used to stratify patients with pancreatic cancer according to the possibility of R0 resection. Larger tumor size and tumor abutment to the portomesenteric vein are associated with margin-positive resection in patients with resectable pancreatic cancer.

Clinical Significance of Neoadjuvant Chemotherapy With Gemcitabine Plus S-1 for Resectable Pancreatic Ductal Adenocarcinoma

“…PDAC has been classified into three categories: i) resectable (R), ii) borderline resectable (BR), or iii) unresectable (UR), based on residual tumor status evaluated by contrast-enhanced multidetector-row computed tomography (MDCT). Although a better R0 resection rate can be achieved in patients with R-PDAC compared to patients with BR-or UR-PDAC, the 5year OS remains unsatisfactory (8)(9)(10).…”

CT criteria of the resectability of pankreas carcinoma

“…In 2016, an international consensus was adopted in Japan to standardize the classification of pancreatic cancer resectability [6,7]. Today, pancreatic cancer is considered resectable when tumor mass does not affect the arterial blood vessels of the upper mesenteric artery (AMS), the coeliac trunk (TC) and the common hepatic artery (ACH), the blood vessels of the upper mesenteric vein (VMS), and/or vena portalis (VP) or narrows them by less than 180° [8].…”

Radiomics-Assisted Presurgical Prediction for Surgical Portal Vein-Superior Mesenteric Vein Invasion in Pancreatic Ductal Adenocarcinoma

“…Several imaging features for evaluating surgical PV-SMV invasion have been introduced, including encasement (>180°) of the tumor-vein relationship (13), deformation, narrowed or stenotic morphology of PV-SMV (14), and the teardrop sign (15). Unfortunately, such above qualitative imaging findings do not accurately classify vascular involvement, especially in peripancreatic venous involvement (16)(17)(18). Also, a recent study showed that agreements in the interpretation of tumor-vascular relationships were low among different observers (19).…”