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Preoperative radiographic vascular involvement score predicts the prognosis of resected pancreatic head adenocarcinoma

Langenbeck's Archives of Surgery volume 402, pages 439–446 (2017)Cite this article

Abstract

Background

Operative indications for pancreatic head adenocarcinoma (PHC) with vascular invasion remain unclear. We aimed to develop a new prognostic model focusing on preoperative portal/superior mesenteric vein (PV/SMV) and superior mesenteric artery (SMA) invasiveness.

Methods

From 2005 to 2012, 103 patients underwent pancreatoduodenectomy for PHC. The CT findings for both PV/SMV and SMA invasion were evaluated separately [PV/SMV, none (score 0), unilateral narrowing (score 1), bilateral narrowing/stenosis (score 2); SMA, none or <90° (score 0), ≥90° (score 3)]. The total score defined the preoperative vascular involvement score (VI score); VI scores 0 (n = 39), 1 (n = 32), 2 (n = 17) and ≥3 (n = 15) were compared.

Results

PV/SMV resection was performed in 1 (3%), 29 (91%), 16 (94%) and 13 (87%) cases of VI scores 0, 1, 2 and ≥3, respectively (P < 0.001). No patients with VI scores ≥3 had margin-negative resection; pathologically curative resection was achieved in 37 of 39 (95%), 27 of 32 (84%) and 13 of 17 (76%) patients with VI scores of 0, 1 and 2, respectively (P < 0.001). The survival rate and median survival time (MST) were reduced with an increasing VI score (MST, 40.9, 16.5, 8.9 and 6.3 months, respectively). The comparison of each survival curve revealed significant differences (P < 0.005), except when comparing VI scores 1 and 2 (P = 0.134).

Conclusions

Higher VI score predicts shorter survival. Proposed scoring system may be useful for determining the choice between undergoing neoadjuvant treatment, or upfront resection with adjuvant treatment.

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Affiliations

  1. Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan

    Shunsuke Onoe, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama & Yasuyuki Fukami

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  1. Shunsuke Onoe
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  2. Yuji Kaneoka
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  3. Atsuyuki Maeda
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  4. Yuichi Takayama
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  5. Yasuyuki Fukami
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Correspondence to Shunsuke Onoe.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflicts of interest.

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Onoe, S., Kaneoka, Y., Maeda, A. et al. Preoperative radiographic vascular involvement score predicts the prognosis of resected pancreatic head adenocarcinoma. Langenbecks Arch Surg 402, 439–446 (2017). https://doi.org/10.1007/s00423-017-1562-0

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  • DOI: https://doi.org/10.1007/s00423-017-1562-0

Keywords

  • Pancreatic head adenocarcinoma
  • Vessel involvement
  • Borderline resectable
  • Scoring system