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Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings.

Publication ,  Journal Article
Fong, ZV; Tan, WP; Lavu, H; Kennedy, EP; Mitchell, DG; Koniaris, LG; Sauter, PK; Rosato, EL; Yeo, CJ; Winter, JM
Published in: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
June 2013

High-resolution, multiphase, computed tomography (CT) is a standard preoperative test prior to pancreatectomy, yet the clinical significance of routinely reported findings remains unknown.We identified patients who underwent a pancreaticoduodenectomy for a periampullary adenocarcinoma (PA) over the previous 5 years and had a pancreas protocol CT at our institution. Clinicopathologic implications of reported CT findings were evaluated.There were 155 pancreatic ductal adenocarcinomas (PDA) and 47 non-pancreatic PAs. No mass was visualized on CT in 6 % of PDAs and 23 % of non-pancreatic PA. A size discrepancy of ≥1 cm between radiographic and pathologic tumor diameters was observed in 40 % of PAs, with CT underestimating the size in most instances (75 %). Radiographically enlarged lymph nodes were not associated with true lymph node metastases in PDAs (70 % lymph node positive cases were enlarged on CT vs 74 % lymph node negative, p = 0.5), but were associated with a preoperatively placed biliary endoprosthesis (63 % with endoprosthesis were enlarged vs 37 % no endoprosthesis, p = 0.013). Major visceral vessel involvement on CT was not associated with a vascular resection (3 % with CT vessel involvement vs 2 % without, p = 0.8) or a positive uncinate resection margin (24 vs 20 %, respectively, p = 0.6).While dedicated pancreas protocol CT provides unprecedented detail, the test may lead to overinterpretation of the extent of disease in some instances. A radiographic suggestion of enlarged lymph nodes and vascular involvement does not necessarily preclude exploration with curative intent. CTs with local disease should be reported in an objective template and carefully reviewed by a multidisciplinary group of surgeons, radiologists, and oncologists to avoid missing an opportunity for neoadjuvant therapy or cure by resection.

Published In

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

DOI

EISSN

1873-4626

ISSN

1091-255X

Publication Date

June 2013

Volume

17

Issue

6

Start / End Page

1098 / 1106

Related Subject Headings

  • Tumor Burden
  • Surgery
  • Retrospective Studies
  • Preoperative Care
  • Portal Vein
  • Pancreatic Neoplasms
  • Pancreatic Ducts
  • Multidetector Computed Tomography
  • Mesenteric Veins
  • Mesenteric Artery, Superior
 

Citation

APA
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MLA
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Fong, Z. V., Tan, W. P., Lavu, H., Kennedy, E. P., Mitchell, D. G., Koniaris, L. G., … Winter, J. M. (2013). Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 17(6), 1098–1106. https://doi.org/10.1007/s11605-013-2181-x
Fong, Zhi Ven, Wei Phin Tan, Harish Lavu, Eugene P. Kennedy, Donald G. Mitchell, Leonidas G. Koniaris, Patricia K. Sauter, Ernest L. Rosato, Charles J. Yeo, and Jordan M. Winter. “Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings.Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract 17, no. 6 (June 2013): 1098–1106. https://doi.org/10.1007/s11605-013-2181-x.
Fong ZV, Tan WP, Lavu H, Kennedy EP, Mitchell DG, Koniaris LG, et al. Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2013 Jun;17(6):1098–106.
Fong, Zhi Ven, et al. “Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings.Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 17, no. 6, June 2013, pp. 1098–106. Epmc, doi:10.1007/s11605-013-2181-x.
Fong ZV, Tan WP, Lavu H, Kennedy EP, Mitchell DG, Koniaris LG, Sauter PK, Rosato EL, Yeo CJ, Winter JM. Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2013 Jun;17(6):1098–1106.
Journal cover image

Published In

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

DOI

EISSN

1873-4626

ISSN

1091-255X

Publication Date

June 2013

Volume

17

Issue

6

Start / End Page

1098 / 1106

Related Subject Headings

  • Tumor Burden
  • Surgery
  • Retrospective Studies
  • Preoperative Care
  • Portal Vein
  • Pancreatic Neoplasms
  • Pancreatic Ducts
  • Multidetector Computed Tomography
  • Mesenteric Veins
  • Mesenteric Artery, Superior