Christophe Cassinotto1, Anthony Dohan2, George Zogopoulos3, Laurence Chiche4, Christophe Laurent5, Antonio Sa-Cunha6, Adeline Cuggia7, Caroline Reinhold8, Benoît Gallix9. 1. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada; Department of Diagnostic and Interventional Radiology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France. Electronic address: Cassinotto@gmail.com. 2. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada. Electronic address: Anthony.dohan@mcgill.ca. 3. Department of Visceral Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada. Electronic address: George.zogopoulos@mcgill.ca. 4. Department of Visceral Surgery, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France. Electronic address: Laurence.chiche@chu-bordeaux.fr. 5. Department of Visceral Surgery, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France. Electronic address: Christophe.laurent@chu-bordeaux.fr. 6. Department of Visceral Surgery, Hôpital Paul Brousse, Assistance Publique des Hôpitaux de Paris, Villejuif, France. Electronic address: antonio.sacunha@aphp.fr. 7. Department of Visceral Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada. Electronic address: adeline.cuggia@mcgill.ca. 8. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada. Electronic address: caroline.reinhold@mcgill.ca. 9. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada. Electronic address: benoit.gallix@mcgill.ca.
Abstract
BACKGROUND: Negative-margin status is a prognostic indicator for long-term survival following curative intent resection for pancreatic adenocarcinoma. Patients at increased risk for positive-margin resections may benefit from neoadjuvant chemotherapy prior to resection. METHODS: We retrospectively analyzed preoperative computed-tomography (CT) scans in 108 consecutive patients that underwent curative intent resection for a resectable pancreatic ductal adenocarcinoma from 2009 to 2016 in two academic hospitals. Two radiologists independently staged the tumor, including tumor location, size, and tumor-to-superior mesenteric/portal vein (SMV/PV) contact. Uni and multivariate analysis were performed to identify independent predictors of an R1 resection. RESULTS: Twenty-nine patients had an R1 resection (26.9%). Tumor size, location, and presence of tumor-to-SMV/PV contact were significantly associated with an R1 resection. In multivariate analysis, the independent parameters associated with resection status were: tumor size (R2=9.7), and tumor location (neck R2=6.6; pancreaticoduodenal interface R2=4.4; uncinate process R2=4.1), but not tumor-to-SMV/PV contact (R2=0.1, p=0.7). A simple CT score was built based on tumor size and location. Patients with an R0 resectability score ≥3, i.e. patients with tumor size ≥30mm (except when tumor location is at the pancreatico-duodenal interface) or patients with tumor size ≥20mm AND tumor located in the uncinate process or neck, were at high-risk of an R1 resection (AUC, 0.82; sensitivity, 79%; specificity, 76%). This score also showed good diagnostic performances for predicting an R1 resection involving the medial resection margin only (AUC, 0.85). CONCLUSIONS: A simple score based on tumor location and size can accurately predict patients at high-risk of an R1 resection.
BACKGROUND: Negative-margin status is a prognostic indicator for long-term survival following curative intent resection for pancreatic adenocarcinoma. Patients at increased risk for positive-margin resections may benefit from neoadjuvant chemotherapy prior to resection. METHODS: We retrospectively analyzed preoperative computed-tomography (CT) scans in 108 consecutive patients that underwent curative intent resection for a resectable pancreatic ductal adenocarcinoma from 2009 to 2016 in two academic hospitals. Two radiologists independently staged the tumor, including tumor location, size, and tumor-to-superior mesenteric/portal vein (SMV/PV) contact. Uni and multivariate analysis were performed to identify independent predictors of an R1 resection. RESULTS: Twenty-nine patients had an R1 resection (26.9%). Tumor size, location, and presence of tumor-to-SMV/PV contact were significantly associated with an R1 resection. In multivariate analysis, the independent parameters associated with resection status were: tumor size (R2=9.7), and tumor location (neck R2=6.6; pancreaticoduodenal interface R2=4.4; uncinate process R2=4.1), but not tumor-to-SMV/PV contact (R2=0.1, p=0.7). A simple CT score was built based on tumor size and location. Patients with an R0 resectability score ≥3, i.e. patients with tumor size ≥30mm (except when tumor location is at the pancreatico-duodenal interface) or patients with tumor size ≥20mm AND tumor located in the uncinate process or neck, were at high-risk of an R1 resection (AUC, 0.82; sensitivity, 79%; specificity, 76%). This score also showed good diagnostic performances for predicting an R1 resection involving the medial resection margin only (AUC, 0.85). CONCLUSIONS: A simple score based on tumor location and size can accurately predict patients at high-risk of an R1 resection.
Authors: Amir A Borhani; Rohit Dewan; Alessandro Furlan; Natalie Seiser; Amer H Zureikat; Aatur D Singhi; Brian Boone; Nathan Bahary; Melissa E Hogg; Michael Lotze; Herbert J Zeh; Mitchell E Tublin Journal: AJR Am J Roentgenol Date: 2019-12-04 Impact factor: 3.959
Authors: Taiga Wakabayashi; Farid Ouhmich; Cristians Gonzalez-Cabrera; Emanuele Felli; Antonio Saviano; Vincent Agnus; Peter Savadjiev; Thomas F Baumert; Patrick Pessaux; Jacques Marescaux; Benoit Gallix Journal: Hepatol Int Date: 2019-08-31 Impact factor: 9.029
Authors: Shannan M Dickinson; Caitlin A McIntyre; Juliana B Schilsky; Kate A Harrington; Scott R Gerst; Jessica R Flynn; Mithat Gonen; Marinela Capanu; Winston Wong; Sharon Lawrence; Peter J Allen; Eileen M O'Reilly; William R Jarnagin; Michael I D'Angelica; Vinod P Balachandran; Jeffrey A Drebin; T Peter Kingham; Amber L Simpson; Richard K Do Journal: Abdom Radiol (NY) Date: 2020-09-28