Lapshyn Hryhoriy, Schulte Theresa, Sondermann Stefan, May Katharina, Petrova Ekaterina, Honselmann Kim C, Braun Rüdiger, Zemskov Sergii, Keck Tobias, Wellner Ulrich F, Bausch Dirk, Bolm Louisa
Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
Pancreatology. 2021 Jan;21(1):155-162. doi: 10.1016/j.pan.2020.11.015. Epub 2020 Dec 5.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy characterized by early loco-regional invasion. Portal vein resection (PVR) during pancreatoduodenectomy (PD) for PDAC is performed if tumor cell invasion to the venous wall (PVI) is suspected. The aim of this study is to evaluate radiological criteria for predicting PVR and PVI.
Patients undergoing PD for PDAC were identified from a prospectively maintained database. On the basis of CT- and MRI-based imaging portal vein tumor contact (PV), stranding of the superior mesenteric artery (SMA) and any alterations of the superior mesenterico-portal vein (SMPV) were evaluated. The accuracy of PVI and PVR prediction based on the radiological parameters was calculated.
143 patients were included in the study. 48 patients underwent PVR (34%), PVI was diagnosed in 23 patients (16%). Median overall survival was 22 months. Prediction of PVR (sensitivity 79%, negative predictive value 88%, p = 0.010) and PVI (sensitivity 95%, negative predictive value 99%, p = 0.002) was most accurate for any SMPV alterations as compared to the other radiological parameters. SMPV alterations qualified as an independent prognostic parameter (26.5 months vs. 33.5months, p = 0.034).
Radiological evaluation of any SMPV alterations is a simple preoperative method to accurately predict PVI. Assessing SMPV alterations may help to identify candidates for neoadjuvant therapy.
胰腺导管腺癌（PDAC）是一种侵袭性胃肠道恶性肿瘤，其特征为早期局部区域侵犯。如果怀疑肿瘤细胞侵犯静脉壁（PVI），则在胰腺癌的胰十二指肠切除术（PD）期间进行门静脉切除（PVR）。本研究的目的是评估预测PVR和PVI的放射学标准。
从一个前瞻性维护的数据库中识别接受PDAC的PD治疗的患者。基于CT和MRI成像评估门静脉肿瘤接触（PV）、肠系膜上动脉（SMA）的条索状改变以及肠系膜上 - 门静脉（SMPV）的任何改变。计算基于放射学参数的PVI和PVR预测的准确性。
143例患者纳入研究。48例患者接受了PVR（34%），23例患者诊断为PVI（16%）。中位总生存期为22个月。与其他放射学参数相比，任何SMPV改变对PVR（敏感性79%，阴性预测值88%，p = 0.010）和PVI（敏感性95%，阴性预测值99%，p = 0.002）的预测最为准确。SMPV改变被认为是一个独立的预后参数（26.5个月对33.5个月，p = 0.034）。
对任何SMPV改变进行放射学评估是一种简单的术前方法，可准确预测PVI。评估SMPV改变可能有助于识别新辅助治疗的候选者。
