The evaluation and diagnosis of pancreatic cancer is now largely initially accomplished through radiographic means, including CT scanning. This has produced changes in related areas such as the staging of pancreatic cancer, and the evaluation for potential resection. Depending on tumor extension, as a part of the Whipple, the surgeon may need to surgically resect the superior mesenteric vein – portal vein complex (“SMV-PV”).
Researcher Katz and colleagues at the University of Texas / M.D. Anderson Cancer Center in Houston wondered if the necessity of the likelihood of this vascular aspect of the surgical procedure could be anticipated among resectable and borderline resectable cases using CT scan criteria. Their results were published in the February 2014 issue of the Journal of Gastrointestinal Surgery, the official publication of the Society for Surgery of the Alimentary Tract.
The researchers reviewed all patients who received the pancreaticoduodenectomy (Whipple procedure) at the M.D. Anderson Cancer Center for a seven year period (2004-2011). This process eventually yielded 254 patients who met inclusion standards (39.6% of these patients eventually required SMV-PV resection at surgery). The authors reexamined the CT images of these patients taken prior to surgery in regard to the extent of the tumor / SMV-PV interface in terms of four categories: no interface, less than or equal to 180° of interface, more than 180° of interface, or full occlusion.
The authors found that 89.5% of patients with either full occlusion of the vein complex or those with more than 180° of interface had received the SMV-PV resection. Also, they found that those with less than or equal to 180° of interface tended to have longer survival.
They conclude that this method of classification can be of help in surgical planning, and in prognosis. This is an interesting study suggesting fairly easy measurements that may that may prove to be very useful.
Dale O’Brien, MD