Imaging Evaluation of Resectability

  • Ashish Verma


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.


Pancreatic cancer Periampullary cancer Resectability Preoperative evaluation 


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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Ashish Verma
    • 1
  1. 1.Department of Radiodiagnosis and ImagingInstitute of Medical Sciences, Banaras Hindu UniversityVaranasiIndia

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