Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 269–278

Radiographic Tumor–Vein Interface as a Predictor of Intraoperative, Pathologic, and Oncologic Outcomes in Resectable and Borderline Resectable Pancreatic Cancer

  • Hop S. Tran Cao
  • Alpana Balachandran
  • Huamin Wang
  • Graciela M. Nogueras-González
  • Christina E. Bailey
  • Jeffrey E. Lee
  • Peter W. T. Pisters
  • Douglas B. Evans
  • Gauri Varadhachary
  • Christopher H. Crane
  • Thomas A. Aloia
  • Jean-Nicolas Vauthey
  • Jason B. Fleming
  • Matthew H. G. Katz
2013 SSAT Plenary Presentation

DOI: 10.1007/s11605-013-2374-3

Cite this article as:
Tran Cao, H.S., Balachandran, A., Wang, H. et al. J Gastrointest Surg (2014) 18: 269. doi:10.1007/s11605-013-2374-3

Abstract

Background

Venous resection may be required to achieve complete resection of pancreatic cancers. We assessed the ability of radiographic criteria to predict the need for superior mesenteric–portal vein (SMV-PV) resection and the presence of histologic vein invasion.

Methods

All patients who underwent pancreaticoduodenectomy from 2004 to 2011 at the authors’ institution were identified. Preoperative pancreatic protocol CT images were re-reviewed to characterize the extent of tumor–vein circumferential interface (TVI) as demonstrating no interface, ≤180° of vessel circumference, >180° of vessel circumference, or occlusion. Findings were correlated with the need for venous resection, histologic venous invasion, and survival.

Results

A total of 254 patients underwent pancreaticoduodenectomy and met inclusion criteria; 98 (39.6 %) required SMV-PV resection. In our cohort, 76.4 % of patients received neoadjuvant chemoradiation. The TVI classification system predicted with fair accuracy both the need for SMV-PV resection at the time of surgery and histologic invasion of the vein. In particular, 89.5 % of patients with TVI >180° or occlusion required SMV-PV resection. Of those, 82.4 % had documented histologic SMV-PV invasion. TVI ≤180° was associated with favorable overall survival compared to a greater circumferential interface.

Conclusions

A tomographic classification of the tumor–SMV-PV interface can predict the need for venous resection, pathologic venous involvement, and survival. To assist in treatment planning, a standardized assessment of this anatomic relationship should be routinely performed.

Keywords

Pancreatic adenocarcinoma Borderline resectable Superior mesenteric vein Portal vein Computed tomography 

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Hop S. Tran Cao
    • 1
  • Alpana Balachandran
    • 2
  • Huamin Wang
    • 3
  • Graciela M. Nogueras-González
  • Christina E. Bailey
    • 1
  • Jeffrey E. Lee
    • 1
  • Peter W. T. Pisters
    • 1
  • Douglas B. Evans
    • 7
  • Gauri Varadhachary
    • 5
  • Christopher H. Crane
    • 6
  • Thomas A. Aloia
    • 1
  • Jean-Nicolas Vauthey
    • 1
  • Jason B. Fleming
    • 1
  • Matthew H. G. Katz
    • 1
  1. 1.Department of Surgical OncologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of Diagnostic ImagingThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of PathologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  4. 4.Department of BiostatisticsThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  5. 5.Department of Medical OncologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  6. 6.Department of Radiation OncologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  7. 7.Department of SurgeryMedical College of WisconsinMilwaukeeUSA