Staging Computed Tomography in Patients with Noncurative Laparotomy for Periampullary Cancer: Does Nonstructured Reporting Adequately Communicate Resectability?

Abstract

Periampullary cancer (PC) is a term encompassing malignancies that originate near the ampulla of Vater. It includes cancers of the head and neck of the pancreas, distal common bile duct, second part of the duodenum, and the ampulla itself. Differentiating between these entities, even with biopsy, is often not possible. Therefore, PC is managed identically to pancreatic adenocarcinoma, the fourth leading cause of cancer death in the United States despite representing only 3.1% of new cancer diagnoses [1]. Surgical resection by pancreaticoduodenectomy is the only potentially curative measure [2]. Unfortunately, as PC frequently presents at an advanced stage (particularly pancreatic adenocarcinoma), it is often inoperable at the time of diagnosis [3]. The 2016 National Comprehensive Cancer Network (NCCN) Guidelines for Pancreatic Adenocarcinoma define criteria to determine resectability [2]. Nonetheless, a subset of patients undergo noncurative laparotomy (NCL) either because the resection is 1) margin positive (termed an R1 resection) [4,5] or 2) the disease is found to be unresectable due to local invasion or unexpected metastases [6,7]. Although it is not the preferred outcome, NCL can benefit patients via definitive staging in borderline resectable cases, surgical bypass of obstructed bowel or bile ducts, placement of fiducial markers for radiation therapy, and tumour debulking.

Real‐world staging computed tomography scanning technique and important reporting discrepancies in pancreatic ductal adenocarcinoma

“…[20][21][22] More targeted studies have found that sub-specialist reporting of PDAC resulted in greater clarity regarding resection attempts. 21,23 Sub-specialist review often upstages patients and thus prevents unsuccessful resection attempts. 17,19 Given the importance of accurate initial PDAC imaging staging, this study investigated applied CT scanning technique and discrepancies between initial versus sub-specialist radiologist reporting regarding synoptic template usage, report completeness and staging in real-world setting.…”

“…Early studies examining discrepancies in PDAC found reporting discrepancies in 31–32% of cases and concluded that second interpretation was a cost‐effective method of determining resectability in patients 20–22 . More targeted studies have found that sub‐specialist reporting of PDAC resulted in greater clarity regarding resection attempts 21,23 . Sub‐specialist review often upstages patients and thus prevents unsuccessful resection attempts 17,19 …”