Spiral computed tomography for preoperative staging of potentially resectable carcinoma of the pancreatic head

Abstract

General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Background: Pancreatic cancer is often locally invasive. Preoperative staging attempts to identify patients suitable for resection, in order to minimize unnecessary operations. The aim of this study was to assess the improved imaging provided by spiral computed tomography (CT) in the preoperative staging of potentially resectable pancreatic head carcinoma. Methods: In 56 consecutive patients with pancreatic head carcinoma spiral CT ®ndings were correlated prospectively with operative and histopathological ®ndings. Criteria for irresectability at CT were in®ltration of the peripancreatic fat and vascular ingrowth grade D, on a scale from A to F.Results: At operation 27 (48 per cent) of 56 tumours were irresectable. Small metastases were found in seven patients (12 per cent). Ingrowth (adherence) to the portal or mesenteric vein was present in 19 patients (34 per cent). The sensitivity and speci®city of CT for irresectability were 78 and 76 per cent respectively. Resection rates with a vascular margin free of tumour were 100 per cent for grade A, 63 per cent for grade B, 44 per cent for grade C, 15 per cent for grade D and 0 per cent for grade E, with a predictive value for ingrowth of 88 per cent for grades D or higher. The resectability rate was 11 per cent (one of nine) when in®ltration of the anterior peripancreatic fat was present and 67 per cent when in®ltration was absent (P < 0´01).Conclusion: Spiral CT with thin slices seems to improve detection of distant metastases and vascular ingrowth in patients with pancreatic head carcinoma.

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

“…Nowadays, stateof-the-art radiological techniques offer a higher diagnostic accuracy than ERCP, require a minimum amount of time, are noninvasive, and have the advantage of assessing local tumor extension, as well as distant metastases. [45][46][47] Therefore, ERCP as a diagnostic tool is considered obsolete in many countries, although geographical differences do exist. Implementation of a strategy without diagnostic ERCP is not generally adapted yet in The Netherlands; a survey revealed that, prior to referral for further assessment and (surgical) treatment at the tertiary center, almost 40% of patients already had ERCP performed, primarily as a diagnostic procedure.…”

Complications in Surgery – Let’s Face Them

“…Modern imaging techniques, as helical CT scan [4], endoultrasound and PET scanning can prevent unnecessary laparotomies and diagnostic laparoscopy can prevent more invasive laparotomies, although the yield is rather limited in pancreatic cancer [5]. The choice to perform surgical procedures with extended lymph node dissection should be made on scientific evidence and not on personal preference, especially since extended lymph node dissection leads to more complications [6, 7].…”

Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours

“…Loyer et al (1996) have described a grading system of vascular involvement based on a dynamic series of 1.5 mm thickness scans in patients with pancreatic adenocarcinoma (Table 1). Along with other groups, they have reported a decreasing rate of resectability with increasing grades of vascular involvement (Loyer et al, 1996;Phoa et al, 1999;Saldinger et al, 2000).…”