Pande Rupaly, Liu Wingyan, Raza Syed S, Papamichail Michail, Suthananthan Arul E, Bartlett David C, Marudanayagam Ravi, Dasari Bobby V M, Sutcliffe Robert P, Roberts Keith J, Wadhwani Sharan, Chatzizacharias Nikolaos
Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK.
Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK.
Diagnostics (Basel). 2024 Jan 7;14(2):135. doi: 10.3390/diagnostics14020135.
Surgery-first approach is the current standard of care for resectable pancreatic ductal adenocarcinoma (PDAC), and a proportion of these cases will require venous resection. This study aimed to identify parameters on staging computed tomography (CT) that predict the need for venous resection during pancreaticoduodenectomy (PD) for resectable PDAC.
We conducted a retrospective analysis of prospectively collected data on patients who underwent PD for resectable staged PDAC (as per NCCN criteria) between 2011 and 2020. Staging CTs were independently reviewed by two specialist radiologists blinded to the clinical outcomes. Univariate and multivariate risk analyses were performed.
In total, 296 PDs were included. Venous resection was performed in 62 (21%) cases. There was a higher rate of resection margin positivity in the vein resection group (72.6% vs. 48.7%, = 0.001). Tumour at the neck of the pancreas, superior mesenteric vein involvement of ≥10 mm and pancreatic duct dilatation were identified as independent predictors for venous resection.
Staging CT parameters can predict the need for venous resection during PD for resectable cases of PDAC. This may assist in surgical planning, patient selection and counselling. Future efforts should concentrate on validating these results or identifying additional predictors in a multicentre and prospective setting.
手术优先方法是可切除性胰腺导管腺癌（PDAC）当前的标准治疗方式，其中一部分病例需要进行静脉切除。本研究旨在确定分期计算机断层扫描（CT）上能够预测可切除性PDAC患者在胰十二指肠切除术（PD）期间是否需要进行静脉切除的参数。
我们对2011年至2020年间因可切除分期PDAC（根据美国国立综合癌症网络（NCCN）标准）接受PD手术的患者的前瞻性收集数据进行了回顾性分析。分期CT由两名对临床结果不知情的专科放射科医生独立审查。进行了单因素和多因素风险分析。
总共纳入了296例PD手术。62例（21%）进行了静脉切除。静脉切除组的切缘阳性率更高（72.6%对48.7%，P = 0.001）。胰腺颈部肿瘤、肠系膜上静脉受累≥10 mm以及胰管扩张被确定为静脉切除的独立预测因素。
分期CT参数可以预测可切除性PDAC患者在PD期间是否需要进行静脉切除。这可能有助于手术规划、患者选择和咨询。未来的工作应集中在多中心前瞻性研究中验证这些结果或确定其他预测因素。
