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Imaging Evaluation of Resectability

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Surgery for Pancreatic and Periampullary Cancer

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Abstract

The approach and feasibility of surgery in periampullary tumors depends upon the vascular invasion and systemic dissemination caused by the lesion. Such decisive factors may now be clearly delineated by imaging surrogates derived from advanced imaging modalities executing tailored algorithms and specific imaging maneuvers. Further sophisticated image manipulation and post-processing may bring out certain features which are not apparent on baseline images. This enables a rational approach in choice of imaging modality and in perusing the management protocol as such. Pancreatic adenocarcinoma is among the top five cancers as per incidence and has one of the worst 5-year survival rates. This ranges from 6.8 to 15% in nonmetastatic locally aggressive disease, with the presence of distant metastases reducing it to 1.8%. However, the survival rate may be enhanced to 15–27% by an R0 resection, a scenario possible in only 10–15% of patients. Further imaging-based characterization of the possible histopathology of lesion may help in differentiating a benign pseudocyst from a cystic tumor of the pancreas, a mucinous cystic tumor from a serous tumor, and a neuroendocrine tumor from other solid neoplasias may help in determination of resectability of each of these pancreatic lesions. The present review aims at establishing a stepwise approach whereby one should begin by deconvoluting the exact organ of origin (i.e., pancreatic versus biliary or duodenal), followed by elaboration of specific features governing resectability. Notably pancreatic lesions have the worst prognosis among lesions of this region, and most treatment failures are due to improper preoperative characterization/subclassification and vascular mapping in relation to the lesion.

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  1. Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Ashish Verma

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  1. Ashish Verma
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  1. Chief Hepato-Pancreato-Biliary and Gastrointestinal Division, Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India

    Mallika Tewari

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Verma, A. (2018). Imaging Evaluation of Resectability. In: Tewari, M. (eds) Surgery for Pancreatic and Periampullary Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-7464-6_4

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  • DOI: https://doi.org/10.1007/978-981-10-7464-6_4

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