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| The critical point of the peripancreatic blood vessels by pancreatic cancer invasion can be removed |
1. Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100026, China;
2. Department of Pathology, Tsinghua University First Hospital, Beijing 100016, China |
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Abstract Objective: To explore the critical point of imaging findings, in which the invaded peripancreatic blood vessels could be operability by surgery. Methods: A total of 76 cases of patients with distant metastasis-free pancreatic cancer confirmed by operative pathology or clinical treatment were enrolled, all of them underwent contrast-enhanced CT before operation. Among them, 66 patients underwent enhanced MRI scanning and three-dimensional vascular reconstruction. According to the images, the extents of pancreatic cancer invasion of peripancreatic vessels were divided into grade 0, grade 1, grade 2, grade 3, and grade 4. The numbers of vessels in each grade were counted and compared to the results of operation. Results: There were 138 vessels in 39 cases with invasion extent higher than grade 2, so the operations were given up. A total of 37 cases were assessed with the possibility of operative excision before operation. Among them, 25 cases accepted radical excision of pancreas, however, 12 cases accepted tumor resection or palliative therapy alone because of preoperative underestimate of the invasion extent of one or more vessels. In these 12 cases, the invasion extents of 16 arteries and 21 veins were underestimated. Operative excision could not be executed if the invasion extent was assessed as grade 3 and 4 during operation, while it could be executed if the invasion extent was assessed as grade 0 and 1 during operation. Moreover, operative excision depended on the condition of patients if the invasion extent was assessed as grade 2. Conclusion: Preoperative multi-phase CT, MRI scanning and 3D vascular remodeling, it is very important to evaluate the operability before operation. Level 2 arterial invasion and level 1 vein invasion can be the critical point of resection.
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Received: 30 March 2015
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