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Preoperative assessment of the resectability of pancreatic ductal adenocarcinoma on CT according to the NCCN Guidelines focusing on SMA/SMV branch invasion

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

For patients with pancreatic adenocarcinoma (PAC), adequate determination of disease extent is critical for optimal management. We aimed to evaluate diagnostic accuracy of CT in determining the resectability of PAC based on 2020 NCCN Guidelines.

Methods

We retrospectively enrolled 368 consecutive patients who underwent upfront surgery for PAC and preoperative pancreas protocol CT from January 2012 to December 2017. The resectability of PAC was assessed based on 2020 NCCN Guidelines and compared to 2017 NCCN Guidelines using chi-square tests. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using log-rank test. R0 resection–associated factors were identified using logistic regression analysis.

Results

R0 rates were 80.8% (189/234), 67% (71/106), and 10.7% (3/28) for resectable, borderline resectable, and unresectable PAC according to 2020 NCCN Guidelines, respectively (p < 0.001). The estimated 3-year OS was 28.9% for borderline resectable PAC, which was significantly lower than for resectable PAC (43.6%) (p = 0.004) but significantly higher than for unresectable PAC (0.0%) (p < 0.001). R0 rate was significantly lower in patients with unresectable PAC according to 2020 NCCN Guidelines (10.7%, 3/28) than in those with unresectable PAC according to the previous version (31.7%, 20/63) (p = 0.038). In resectable PAC, tumor size ≥ 3 cm (p = 0.03) and abutment to portal vein (PV) (p = 0.04) were independently associated with margin-positive resection.

Conclusions

The current NCCN Guidelines are useful for stratifying patients according to prognosis and perform better in R0 prediction in unresectable PAC than the previous version. Larger tumor size and abutment to PV were associated with margin-positive resection in patients with resectable PAC.

Key Points

• The updated 2020 NCCN Guidelines were useful for stratifying patients according to prognosis.

• The updated 2020 NCCN Guidelines performed better in the prediction of margin-positive resection in unresectable cases than the previous version.

• Tumor size ≥ 3 cm and abutment to the portal vein were associated with margin-positive resection in patients with resectable pancreatic adenocarcinoma.

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Abbreviations

NCCN:

National Comprehensive Cancer Network

OS:

Overall survival

PAC:

Pancreatic adenocarcinoma

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Sae-Jin Park and Siwon Jang contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea

    Sae-Jin Park, Joon Koo Han & Dong Ho Lee

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea

    Sae-Jin Park, Joon Koo Han & Dong Ho Lee

  3. Department of Radiology, SMG - SNU Boramae Medical Center, Seoul, South Korea

    Sae-Jin Park & Siwon Jang

  4. Department of Surgery, Seoul National University Hospital, Seoul, South Korea

    Hongbeom Kim, Wooil Kwon & Jin-Young Jang

  5. Department of Pathology, Seoul National University Hospital, Seoul, South Korea

    Kyoung-Bun Lee & Haeryoung Kim

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  1. Sae-Jin Park
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Corresponding author

Correspondence to Dong Ho Lee.

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The scientific guarantor of this publication is D.H.L.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Park, SJ., Jang, S., Han, J.K. et al. Preoperative assessment of the resectability of pancreatic ductal adenocarcinoma on CT according to the NCCN Guidelines focusing on SMA/SMV branch invasion. Eur Radiol 31, 6889–6897 (2021). https://doi.org/10.1007/s00330-021-07847-4

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  • DOI: https://doi.org/10.1007/s00330-021-07847-4

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