Predicting resectability of periampullary cancer with three-dimensional computed tomography

The radiographic assessment of extent of tumor burden and local vascular invasion appears to be enhanced with three-dimensional computed tomography (3D-CT). The purpose of this study was to evaluate the impact of preoperative 3D-CT in determining the resectability of patients with periampullary tumo...

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Veröffentlicht in:Journal of gastrointestinal surgery 2004-03, Vol.8 (3), p.280-288
Hauptverfasser: House, Michael G, Yeo, Charles J, Cameron, John L, Campbell, Kurt A, Schulick, Richard D, Leach, Steven D, Hruban, Ralph H, Horton, Karen M, Fishman, Elliot K, Lillemoe, Keith D
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container_end_page 288
container_issue 3
container_start_page 280
container_title Journal of gastrointestinal surgery
container_volume 8
creator House, Michael G
Yeo, Charles J
Cameron, John L
Campbell, Kurt A
Schulick, Richard D
Leach, Steven D
Hruban, Ralph H
Horton, Karen M
Fishman, Elliot K
Lillemoe, Keith D
description The radiographic assessment of extent of tumor burden and local vascular invasion appears to be enhanced with three-dimensional computed tomography (3D-CT). The purpose of this study was to evaluate the impact of preoperative 3D-CT in determining the resectability of patients with periampullary tumors. Intraoperative findings from exploratory laparotomy were gathered prospectively from 140 patients who were thought to have periampullary tumors and were deemed resectable after undergoing preoperative 3D-CT imaging. CT findings were compared to intraoperative findings, and the accuracy of 3D-CT in predicting tumor resectability and, ultimately, the likelihood of obtaining a margin-negative resection were assessed. Of the 140 patients who were thought to have resectable periampullary tumors after preoperative 3D-CT, 115 (82%) were subsequently determined to have periampullary cancer. The remaining 25 patients had benign disease. Among the patients with periampullary cancer, the extent of local tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D-CT in 93% of the patients. 3D-CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels. Preoperative 3D-CT accurately predicted periampullary cancer resectability and a margin-negative resection in 98% and 86% of patients, respectively. For patients with pancreatic adenocarcinoma (n=85), preoperative 3D-CT resulted in a resectability rate and a margin-negative resection rate of 79% and 73%, respectively. The ability of 3D-CT to predict a margin-negative resection for periampullary cancer, including pancreatic adenocarcinoma, relies on its enhanced assessment of the extent of local tumor burden and involvement of the mesenteric vascular anatomy.
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subjects Adenocarcinoma - diagnostic imaging
Adenocarcinoma - surgery
Ampulla of Vater
Cancer
Celiac Artery
Common Bile Duct Neoplasms - diagnostic imaging
Common Bile Duct Neoplasms - surgery
computed tomography
Female
Hepatic Artery
Humans
Imaging, Three-Dimensional
Male
Mesenteric Artery, Superior
Middle Aged
Neoplasm Invasiveness
Pancreatic Neoplasms - diagnostic imaging
Pancreatic Neoplasms - surgery
Periampullary cancer
Predictive Value of Tests
Preoperative Care
Prospective Studies
resection
Sensitivity and Specificity
Tomography, X-Ray Computed - methods
Tumors
vascular invasion
title Predicting resectability of periampullary cancer with three-dimensional computed tomography
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