Radiographic Tumor-Vein Interface as a Predictor of Intraoperative, Pathologic, and Oncologic Outcomes in Resectable and Borderline Resectable Pancreatic Cancer

Hop S. Tran Cao, Alpana Balachandran, Huamin Wang, Graciela M. Nogueras-González, Christina E. Bailey, Jeffrey E. Lee, Peter W.T. Pisters, Douglas B. Evans, Gauri Varadhachary, Christopher H. Crane, Thomas A. Aloia, Jean Nicolas Vauthey, Jason B. Fleming, Matthew H.G. Katz

Research output: Contribution to journalReview articlepeer-review

95 Scopus citations

Abstract

Background: Venous resection may be required to achieve complete resection of pancreatic cancers. We assessed the ability of radiographic criteria to predict the need for superior mesenteric-portal vein (SMV-PV) resection and the presence of histologic vein invasion. Methods: All patients who underwent pancreaticoduodenectomy from 2004 to 2011 at the authors' institution were identified. Preoperative pancreatic protocol CT images were re-reviewed to characterize the extent of tumor-vein circumferential interface (TVI) as demonstrating no interface, ≤180° of vessel circumference, >180° of vessel circumference, or occlusion. Findings were correlated with the need for venous resection, histologic venous invasion, and survival. Results: A total of 254 patients underwent pancreaticoduodenectomy and met inclusion criteria; 98 (39.6 %) required SMV-PV resection. In our cohort, 76.4 % of patients received neoadjuvant chemoradiation. The TVI classification system predicted with fair accuracy both the need for SMV-PV resection at the time of surgery and histologic invasion of the vein. In particular, 89.5 % of patients with TVI >180° or occlusion required SMV-PV resection. Of those, 82.4 % had documented histologic SMV-PV invasion. TVI ≤180° was associated with favorable overall survival compared to a greater circumferential interface. Conclusions: A tomographic classification of the tumor-SMV-PV interface can predict the need for venous resection, pathologic venous involvement, and survival. To assist in treatment planning, a standardized assessment of this anatomic relationship should be routinely performed.

Original languageEnglish (US)
Pages (from-to)269-278
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number2
DOIs
StatePublished - Feb 2014

Keywords

  • Borderline resectable
  • Computed tomography
  • Pancreatic adenocarcinoma
  • Portal vein
  • Superior mesenteric vein

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

MD Anderson CCSG core facilities

  • Biostatistics Resource Group
  • Clinical Trials Office

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