Download PDF
Rofo 2014; 186(1): 23-29
DOI: 10.1055/s-0033-1350190
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Radiologic Resectability Assessment in Pancreatic Cancer

Radiologische Einschätzung der Resektabilität beim Pankreaskarzinom
T. Denecke
1   Institute of Radiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
,
C. Grieser
1   Institute of Radiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
,
P. Neuhaus
2   Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
,
M. Bahra
2   Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

02 July 2012

25 June 2013

Publication Date:
30 September 2013 (online)

Also available at
   Permissions and Reprints

Abstract

Complete tumor resection is still the only potentially curative therapy option for patients with ductal adenocarcinoma of the pancreas. Surgical exploration is the gold standard for the determination of tumor resectability. Radiological resectability assessment is of great importance because many clearly unresectable cases can be identified preoperatively and it became essential for surgical planning. The evolving surgical and radiological techniques demand a continuous reappraisal of radiological criteria in resectability assessment. In the following, the criteria for resection planning are described along with surgical management and the role of radiology in some innovative surgical concepts is explained.

Citation Format:

  • Denecke T, Grieser C, Neuhaus P et al. Radiologic Resectability Assessment in Pancreatic Cancer. Fortschr Röntgenstr 2014; 186: 23 – 29

Zusammenfassung

Für Patienten mit duktalem Adenokarzinom des Pankreas stellt die vollständige Tumorresektion nach wie vor die einzige potenziell kurative Therapieoption dar. Zur Klärung ob eine Tumorresektion möglich ist gilt die chirurgische Exploration als Goldstandard. Die radiologische Einschätzung der Resektabilität vor der Operation ist von entscheidender Bedeutung, da sie viele eindeutig irresektable Fälle präoperativ identifizieren kann und zur Planung des chirurgischen Eingriffs unverzichtbar geworden ist. Die Weiterentwicklungen chirurgischer Techniken und bildgebender Methoden verlangen eine kontinuierliche Neubewertung der Kriterien für eine Einschätzung der Resektabilität anhand radiologischer Diagnostik. Im Folgenden werden die Kriterien für die Resektionsplanung und das chirurgische Vorgehen beschrieben sowie die Rolle der Radiologie bei einigen innovativen chirurgischen Therapiekonzepten erläutert.

Key words

pancreas - CT - MR imaging - resectability - cancer - staging
 

  • References

  • 1 Ferlay J, Shin HR, Bray F et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127: 2893-2917
    CrossrefPubMedGoogle Scholar
  • 2 Bahra M, Neumann U. Surgical techniques for resectable pancreatic cancer. Recent Results Cancer Res 2008; 177: 29-38
    PubMedGoogle Scholar
  • 3 Barugola G, Partelli S, Marcucci S et al. Resectable pancreatic cancer: who really benefits from resection?. Ann Surg Oncol 2009; 16: 3316-3322
    CrossrefPubMedGoogle Scholar
  • 4 Walter J, Nier A, Rose T et al. Palliative partial pancreaticoduodenectomy impairs quality of life compared to bypass surgery in patients with advanced adenocarcinoma of the pancreatic head. Eur J Surg Oncol 2011; 37: 798-804
    CrossrefPubMedGoogle Scholar
  • 5 Grenacher L, Klauss M, Dukic L et al. Hochauflösende Bildgebung beim Pankreaskarzinom: Prospektiver Vergleich von MRT und 4-Zeilen-Spiral-CT. Fortschr Röntgenstr 2004; 176: 1624-1633
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Buerke B, Heiundel W, Wessling J. Differenzialdiagnose und radiologisches Management von zystischen Tumoren des Pankreas. Fortschr Röntgenstr 2010; 182: 852-860
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Grieser C, Heine G, Steffen IG et al. Morphological Analysis and Differentiation of Benign Cystic Neoplasms of the Pancreas Using Computed Tomography and Magnetic Resonance Imaging. Fortschr Röntgenstr 2012; [Epub ahead of print] DOI: 10.1055/s-0032-1325551.
    PubMedGoogle Scholar
  • 8 Hartwig W, Hackert T, Hinz U et al. Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 2009; 250: 81-87
    CrossrefPubMedGoogle Scholar
  • 9 Fletcher JG, Wiersema MJ, Farrell MA et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 2003; 229: 81-90
    CrossrefPubMedGoogle Scholar
  • 10 Koelblinger C, Ba-Ssalamah A, Goetzinger P et al. Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology 2011; 259: 757-766
    CrossrefPubMedGoogle Scholar
  • 11 Fukukura Y, Takumi K, Kamiyama T et al. Pancreatic adenocarcinoma: a comparison of automatic bolus tracking and empirical scan delay. Abdom Imaging 2010; 35: 548-555
    CrossrefPubMedGoogle Scholar
  • 12 Partelli S, Crippa S, Barugola G et al. Splenic artery invasion in pancreatic adenocarcinoma of the body and tail: a novel prognostic parameter for patient selection. Ann Surg Oncol 2011; 18: 3608-3614
    CrossrefPubMedGoogle Scholar
  • 13 Seufferlein T, Adler G. Die S3-Leitlinie Exokrines Pankreaskarzinom. Med Klin (Munich) 2009; 104: 869-874
    CrossrefPubMedGoogle Scholar
  • 14 Boggi U, Del Chiaro M, Croce C et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery 2009; 146: 869-881
    CrossrefPubMedGoogle Scholar
  • 15 Bilimoria KY, Bentrem DJ, Ko CY et al. Validation of the 6th edition AJCC Pancreatic Cancer Staging System: report from the National Cancer Database. Cancer 2007; 110: 738-744
    CrossrefPubMedGoogle Scholar
  • 16 Yekebas EF, Bogoevski D, Cataldegirmen G et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 2008; 247: 300-309
    CrossrefPubMedGoogle Scholar
  • 17 Krumm P, Schraml C, Bretschneider C et al. Depiction of variants of the portal confluence venous system using multidetector row CT: analysis of 916 cases. Fortschr Röntgenstr 2011; 183: 1123-1129
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Loyer EM, David CL, Dubrow RA et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT. Abdom Imaging 1996; 21: 202-206
    CrossrefPubMedGoogle Scholar
  • 19 Nakao A, Kanzaki A, Fujii T et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg 2012; 255: 103-108
    CrossrefPubMedGoogle Scholar
  • 20 Grieser C, Steffen IG, Grajewski L et al. Preoperative multidetector row computed tomography for evaluation and assessment of resection criteria in patients with pancreatic masses. Acta Radiol 2010; 51: 1067-1077
    CrossrefPubMedGoogle Scholar
  • 21 Mollberg N, Rahbari NN, Koch M et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 2011; 254: 882-893
    Google Scholar
  • 22 Lopez Hänninen E, Amthauer H, Hosten N et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology 2002; 224: 34-41
    CrossrefPubMedGoogle Scholar
  • 23 Soriano A, Castells A, Ayuso C et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 2004; 99: 492-501
    CrossrefPubMedGoogle Scholar
  • 24 Lu DS, Reber HA, Krasny RM et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol Am J Roentgenol 1997; 168: 1439-1443
    PubMedGoogle Scholar
  • 25 Grieser C, Denecke T, Steffen IG et al. Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation. Eur Radiol 2010; 20: 108-117
    CrossrefPubMedGoogle Scholar
  • 26 Kaneko OF, Lee DM, Wong J et al. Performance of multidetector computed tomographic angiography in determining surgical resectability of pancreatic head adenocarcinoma. J Comput Assist Tomogr 2010; 34: 732-738
    CrossrefPubMedGoogle Scholar
  • 27 Mayo SC, Austin DF, Sheppard BC et al. Evolving preoperative evaluation of patients with pancreatic cancer: does laparoscopy have a role in the current era?. J Am Coll Surg 2009; 208: 87-95
    CrossrefPubMedGoogle Scholar
  • 28 Balachandran A, Darden DL, Tamm EP et al. Arterial variants in pancreatic adenocarcinoma. Abdom Imaging 2008; 33: 214-221
    CrossrefPubMedGoogle Scholar
  • 29 Pfannenberg C, Schwenzer NF, Bruecher BL. State-of-the-Art-Bildgebung bei Peritonealkarzinose. Fortschr Röntgenstr 2012; 184: 205-213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Glant JA, Waters JA, House MG et al. Does the interval from imaging to operation affect the rate of unanticipated metastasis encountered during operation for pancreatic adenocarcinoma?. Surgery 2011; 150: 607-616
    CrossrefPubMedGoogle Scholar
  • 31 Strobel K, Heinrich S, Bhure U et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med 2008; 49: 1408-1413
    CrossrefPubMedGoogle Scholar
  • 32 Appel BL, Tolat P, Evans DB et al. Current staging systems for pancreatic cancer. Cancer J 2012; 18: 539-549
    CrossrefPubMedGoogle Scholar
  • 33 Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 2010; 257: 674-684
    CrossrefPubMedGoogle Scholar
  • 34 Löwenthal D, Zeile M, Lim WY et al. Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging. Eur Radiol 2011; 21: 832-840
    CrossrefPubMedGoogle Scholar
  • 35 Coenegrachts K, De Geeter F, ter Beek L et al. Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases. Eur Radiol 2009; 19: 370-379
    CrossrefPubMedGoogle Scholar
  • 36 Izuishi K, Yamamoto Y, Sano T et al. Impact of 18-fluorodeoxyglucose positron emission tomography on the management of pancreatic cancer. J Gastrointest Surg 2010; 14: 1151-1158
    CrossrefPubMedGoogle Scholar
  • 37 Kamphues C, Bova R, Schricke D et al. Postoperative complications deteriorate long-term outcome in pancreatic cancer patients. Ann Surg Oncol 2012; 19: 856-856
    CrossrefPubMedGoogle Scholar
  • 38 Pai RK, Beck AH, Mitchem J et al. Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma: direct lymph node invasion has similar survival to node-negative disease. Am J Surg Pathol 2011; 35: 228-234
    CrossrefPubMedGoogle Scholar
  • 39 Slidell MB, Chang DC, Cameron JL et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 2008; 15: 165-174
    CrossrefPubMedGoogle Scholar
  • 40 Imai H, Doi R, Kanazawa H et al. Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol 2010; 15: 294-300
    CrossrefPubMedGoogle Scholar
  • 41 Yamada S, Fujii T, Sugimoto H et al. Pancreatic cancer with distant metastases: a contraindication for radical surgery?. Hepatogastroenterology 2009; 56: 881-5
    PubMedGoogle Scholar
  • 42 Hosein PJ, Macintyre J, Kawamura C et al. A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer 2012; 12: 199
    CrossrefPubMedGoogle Scholar
  • 43 Denecke T, Rau B, Hoffmann KT et al. Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging?. Eur Radiol 2005; 15: 1658-1666
    CrossrefPubMedGoogle Scholar
  • 44 Denecke T, Hundsdörfer P, Misch D et al. Assessment of histological response of paediatric bone sarcomas using FDG PET in comparison to morphological volume measurement and standardized MRI parameters. Eur J Nucl Med Mol Imaging 2010; 37: 1842-1853
    CrossrefPubMedGoogle Scholar
  • 45 Tateishi U, Miyake M, Nagaoka T et al. Neoadjuvant chemotherapy in breast cancer: prediction of pathologic response with PET/CT and dynamic contrast-enhanced MR imaging--prospective assessment. Radiology 2012; 263: 53-63
    CrossrefPubMedGoogle Scholar
  • 46 Tamm EP, Loyer EM, Faria S et al. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy. Abdom Imaging 2006; 31: 568-574
    CrossrefPubMedGoogle Scholar
  • 47 Katz MH, Fleming JB, Bhosale P et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 2012; [Epub ahead of print] DOI: 10.1002/cncr.27636.
    PubMedGoogle Scholar
  • 48 Donahue TR, Isacoff WH, Hines OJ et al. Downstaging chemotherapy and alteration in the classic computed tomography/magnetic resonance imaging signs of vascular involvement in patients with pancreaticobiliary malignant tumors: influence on patient selection for surgery. Arch Surg 2011; 146: 836-843
    CrossrefPubMedGoogle Scholar
  • 49 Kim YE, Park MS, Hong HS et al. Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic head cancer. Radiology 2009; 250: 758-765
    CrossrefPubMedGoogle Scholar
  • 50 Sperti C, Berselli M, Pedrazzoli S. Distal pancreatectomy for body-tail pancreatic cancer: is there a role for celiac axis resection?. Pancreatology 2010; 10: 491-498
    CrossrefPubMedGoogle Scholar
  • 51 Kondo S, Katoh H, Hirano S et al. Ischemic gastropathy after distal pancreatectomy with celiac axis resection. Surg Today 2004; 34: 337-340
    CrossrefPubMedGoogle Scholar
  • 52 Andreou A, Glanemann M, Guckelberger O et al. Pankreaslinksresektion mit Splenektomie und Resektion des Truncus coeliacus bei einem Pankreaskorpuskarzinom mit Infiltration des Truncus coeliacus. Med Klin (Munich) 2010; 105: 227-231
    CrossrefPubMedGoogle Scholar
  • 53 Denecke T, Andreou A, Podrabsky P et al. Distal pancreatectomy with en bloc resection of the celiac trunk for extended pancreatic tumor disease: an interdisciplinary approach. Cardiovasc Intervent Radiol 2011; 34: 1058-1064
    CrossrefPubMedGoogle Scholar
  • 54 Kondo S, Katoh H, Shimizu T et al. Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepatogastroenterology 2000; 47: 1447-1449
    PubMedGoogle Scholar