CONTEXT: Computed tomography is widely used to pre-operatively evaluate patients with ductal carcinoma of the pancreas. OBJECTIVE: To prospectively evaluate the ability of multi-detector computed tomography to predict resectability of pancreatic head cancer. PATIENTS: Ninety-one consecutive patients (53 men, 38 women; mean age, 61 years) referred to our department with a diagnosis of cancer of the head of the pancreas underwent a preoperative contrast enhanced triphasic 16-slice multi-detector computed tomography. Sixty-three were considered inoperable because of advanced local disease, metastatic disease, or poor surgical risk. INTERVENTION: Of the remaining 28 patients, 23 underwent a Whipple procedure, whereas 5 patients underwent a palliative procedure. MAIN OUTCOME MEASURES: Surgical and pathologic reports were reviewed and compared to CT results. RESULTS: Of the 91 patients evaluated, 25% had successful resection of pancreatic head carcinoma; while only 5% had a palliative procedure. When compared to surgical outcome, the positive predictive value of multi-detector computed tomography for resectability was 100%. On the basis of pathologic results, the positive predictive value of multi-detector computed tomography for resectability fell to 83%, Four patients deemed resectable following multi-detector computed tomography had positive margins at pathology. CONCLUSION: The positive predictive value of multi-detector computed tomography for resectable disease is lower when pathologic correlation, as opposed to surgical correlation, is used as the gold standard. Compared to previous studies, there was a lower rate of palliative surgery in our cohort.
CONTEXT: Computed tomography is widely used to pre-operatively evaluate patients with ductal carcinoma of the pancreas. OBJECTIVE: To prospectively evaluate the ability of multi-detector computed tomography to predict resectability of pancreatic head cancer. PATIENTS: Ninety-one consecutive patients (53 men, 38 women; mean age, 61 years) referred to our department with a diagnosis of cancer of the head of the pancreas underwent a preoperative contrast enhanced triphasic 16-slice multi-detector computed tomography. Sixty-three were considered inoperable because of advanced local disease, metastatic disease, or poor surgical risk. INTERVENTION: Of the remaining 28 patients, 23 underwent a Whipple procedure, whereas 5 patients underwent a palliative procedure. MAIN OUTCOME MEASURES: Surgical and pathologic reports were reviewed and compared to CT results. RESULTS: Of the 91 patients evaluated, 25% had successful resection of pancreatic head carcinoma; while only 5% had a palliative procedure. When compared to surgical outcome, the positive predictive value of multi-detector computed tomography for resectability was 100%. On the basis of pathologic results, the positive predictive value of multi-detector computed tomography for resectability fell to 83%, Four patients deemed resectable following multi-detector computed tomography had positive margins at pathology. CONCLUSION: The positive predictive value of multi-detector computed tomography for resectable disease is lower when pathologic correlation, as opposed to surgical correlation, is used as the gold standard. Compared to previous studies, there was a lower rate of palliative surgery in our cohort.
Authors: Chakshu Sharma; Karim M Eltawil; Paul D Renfrew; Mark J Walsh; Michele Molinari Journal: World J Gastroenterol Date: 2011-02-21 Impact factor: 5.742
Authors: Margaret A Tempero; J Pablo Arnoletti; Stephen W Behrman; Edgar Ben-Josef; Al B Benson; Ephraim S Casper; Steven J Cohen; Brian Czito; Joshua D I Ellenhorn; William G Hawkins; Joseph Herman; John P Hoffman; Andrew Ko; Srinadh Komanduri; Albert Koong; Wen Wee Ma; Mokenge P Malafa; Nipun B Merchant; Sean J Mulvihill; Peter Muscarella; Eric K Nakakura; Jorge Obando; Martha B Pitman; Aaron R Sasson; Anitra Tally; Sarah P Thayer; Samuel Whiting; Robert A Wolff; Brian M Wolpin; Deborah A Freedman-Cass; Dorothy A Shead Journal: J Natl Compr Canc Netw Date: 2012-06-01 Impact factor: 11.908
Authors: O Turrini; C M Schmidt; J Moreno; P Parikh; J M Matos; M G House; N J Zyromski; A Nakeeb; H A Pitt; K D Lillemoe Journal: J Gastrointest Surg Date: 2009-05-21 Impact factor: 3.452
Authors: Zhi Cheng; Lauren M Rosati; Linda Chen; Omar Y Mian; Yilin Cao; Marta Villafania; Minoru Nakatsugawa; Joseph A Moore; Scott P Robertson; Juan Jackson; Amy Hacker-Prietz; Jin He; Christopher L Wolfgang; Matthew J Weiss; Joseph M Herman; Amol K Narang; Todd R McNutt Journal: Adv Radiat Oncol Date: 2018-07-19