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Pande R, Liu W, Raza SS, Papamichail M, Suthananthan AE, Bartlett DC, Marudanayagam R, Dasari BVM, Sutcliffe RP, Roberts KJ, Wadhwani S, Chatzizacharias N. Staging Computed Tomography Parameters Predict the Need for Vein Resection during Pancreaticoduodenectomy in Resectable Pancreatic Ductal Adenocarcinoma. Diagnostics (Basel) 2024; 14:135. [PMID: 38248012 PMCID: PMC10814156 DOI: 10.3390/diagnostics14020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%, p = 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. DISCUSSION 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.
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Affiliation(s)
- Rupaly Pande
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Wingyan Liu
- Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (W.L.); (S.W.)
| | - Syed S. Raza
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Michail Papamichail
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Arul E. Suthananthan
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - David C. Bartlett
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Ravi Marudanayagam
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Bobby V. M. Dasari
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Robert P. Sutcliffe
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
| | - Keith J. Roberts
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Sharan Wadhwani
- Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (W.L.); (S.W.)
| | - Nikolaos Chatzizacharias
- Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (R.P.); (S.S.R.); (M.P.); (A.E.S.); (D.C.B.); (R.M.); (B.V.M.D.); (R.P.S.); (K.J.R.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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