Purpose
The salient indication of pancreatic cancer (PC) unresectability is the superior mesenteric
(SMA) and celiac artery (CA) encasement, signaling arterial invasion. Computed
tomography (CT) is the gold standard for PC resectability evaluation.
How to extract patients with Stage II pancreatic cancer (who benefit from radical
surgery) from Stage III group in which they have to be included according to
present regulations if we use only CT (and this is general practice) for diagnostics
of arterial involvement.
Methods and Materials
The data from the preoperative CT and EUS reports on 163 patients consecutively
operated on for ductal adenocarcinoma were compared with the findings at 51 standard,
58 extended, 17 total pancreatoduodenectomies (PDs), 9 distal resections with the CA
excision (DPCA) and 28 palliative bypasses for PDAC between June 2005 and July 2012.
From all of these cases, 11 patients were found who had controversial data of CT and
EUS in regard to peripancreatic arterial tumor invasion. They all had CT signs of arterial
involvement, but curative R0/R1 procedures with or without an excision of the arteries
were performed. Survival in above mentioned group was compared to the survival of
8 patients who underwent an R2 resection (Group B), and of 12 patients with locally
advanced cancer in whom palliative bypass surgery were carried out (Group C). Sixteen
patients who underwent bypass procedure were not included in the study due to the
presence of distant metastases. In the remaining patients no distant metastases were
detected at surgery.
