Jong Jin Hyun1,2, J Bart Rose3, Adnan A Alseidi4, Thomas R Biehl4, Scott Helton4, David L Coy5, Richard A Kozarek2, Flavio G Rocha2,4. 1. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. 2. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington. 3. Division of Surgical Oncology, University of Alabama, Birmingham, Alabama. 4. Section of General, Vascular, and Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington. 5. Section of Radiology, Virginia Mason Medical Center, Seattle, Washington.
Abstract
BACKGROUND AND OBJECTIVES: Unlike pancreatic head tumors, little is known about the biological significance of radiographic vessel involvement with pancreatic body/tail adenocarcinoma. We hypothesized radiographic splenic vessel involvement may be an adverse prognostic factor. METHODS: All distal pancreatectomies performed for resectable pancreatic adenocarcinoma between 2000 and 2016 were reviewed and clinicopatholgic data were collected, retrospectively. Preoperative computed tomography imaging was re-reviewed and splenic vessel involvement was graded as none, abutment, encasement, or occlusion. RESULTS: Among a total of 71 patients, splenic artery or vein encasement/occlusion was present in 41% (29 of 71) of patients, each. There were no significant differences in tumor size or grade, margin positivity, and perineural or lymphovascular invasion. However, splenic artery encasement/occlusion (P = 0.001) and splenic vein encasement/occlusion (P = 0.038) both correlated with lymph node positivity. Splenic artery encasement was associated with a reduced median overall survival (20 vs 30 months, P = 0.033). Multivariate analysis also showed that splenic artery encasement was an independent risk factor of worse survival (hazard ratio, 2.246; 95% confidence interval, 1.118-4.513; P = 0.023). CONCLUSION: Patients with cancer of the body or tail of the pancreas presenting with radiographic encasement of the splenic artery, but not the splenic vein, have a poorer prognosis and perhaps should be considered for neoadjuvant therapy before an attempt at curative resection.
BACKGROUND AND OBJECTIVES: Unlike pancreatic head tumors, little is known about the biological significance of radiographic vessel involvement with pancreatic body/tail adenocarcinoma. We hypothesized radiographic splenic vessel involvement may be an adverse prognostic factor. METHODS: All distal pancreatectomies performed for resectable pancreatic adenocarcinoma between 2000 and 2016 were reviewed and clinicopatholgic data were collected, retrospectively. Preoperative computed tomography imaging was re-reviewed and splenic vessel involvement was graded as none, abutment, encasement, or occlusion. RESULTS: Among a total of 71 patients, splenic artery or vein encasement/occlusion was present in 41% (29 of 71) of patients, each. There were no significant differences in tumor size or grade, margin positivity, and perineural or lymphovascular invasion. However, splenic artery encasement/occlusion (P = 0.001) and splenic vein encasement/occlusion (P = 0.038) both correlated with lymph node positivity. Splenic artery encasement was associated with a reduced median overall survival (20 vs 30 months, P = 0.033). Multivariate analysis also showed that splenic artery encasement was an independent risk factor of worse survival (hazard ratio, 2.246; 95% confidence interval, 1.118-4.513; P = 0.023). CONCLUSION:Patients with cancer of the body or tail of the pancreas presenting with radiographic encasement of the splenic artery, but not the splenic vein, have a poorer prognosis and perhaps should be considered for neoadjuvant therapy before an attempt at curative resection.
Authors: Linda C Chu; Zhen J Wang; Avinash Kambadakone; Elizabeth M Hecht; Jin He; Amol K Narang; Daniel A Laheru; Hina Arif-Tiwari; Priya Bhosale; Candice W Bolan; Olga R Brook; Abraham F Bezuidenhout; Richard K G Do; Samuel J Galgano; Ajit H Goenka; Alexander R Guimaraes; David M Hough; Naveen Kulkarni; Ott Le; Lyndon Luk; Lorenzo Mannelli; Michael Rosenthal; Guillermo Sangster; Zarine K Shah; Erik V Soloff; Parag P Tolat; Marc Zins; Elliot K Fishman; Eric P Tamm; Atif Zaheer Journal: Abdom Radiol (NY) Date: 2022-10-14
Authors: Feng Yin; Mohammed Saad; Jingmei Lin; Christopher R Jackson; Bing Ren; Cynthia Lawson; Dipti M Karamchandani; Belen Quereda Bernabeu; Wei Jiang; Teena Dhir; Richard Zheng; Christopher W Schultz; Dongwei Zhang; Courtney L Thomas; Xuchen Zhang; Jinping Lai; Michael Schild; Xuefeng Zhang; Hao Xie; Xiuli Liu Journal: Gastroenterol Rep (Oxf) Date: 2020-11-24