Determination of Resectability for Pancreatic Head Cancer: Based on the Suspected Vascular Invasion in Abdominal Computed Tomography

PURPOSE: To determine the resectability of pancreatic head cancer by correlating the surgical findings with those of a suspected vascular invasion by abdominal computed tomography (CT). METHODS: The portal vein, superior mesenteric vein, celiac artery, common hepatic artery and superior mesenteric artery were investigated in 100 pancreatic cancer patients who underwent two-phase CT of the pancreas. The degree of vascular encasement, luminal narrowing and the length of the involved segment were analyzed in order to correlate the surgical results. The CT findings and associated unresectable causes were analyzed in those patients who underwent the non-operative treatment. RESULTS: A surgical correlation was available in 66 patients, whose 116 vessels were examined. Vascular encasement was categorized into 5 groups (0: none, 1: < or =90 degree, 2: 91~180 degree, 3: 181~270 degree, 4: 271~360 degree). If category 0, 1 and 2 was determined to be vascular invasion (-), the positive predictive value and negative predictive value were 91.7% and 80% in the veins, and 100% and 75.4% in the arteries. If category 0, 1, 2 and 3 in the vein were determined to be vascular invasion (-), the respective values were 100% and 75.4%. While all the arteries with narrowing were unresectable, some veins with narrowing less than 2/3 of the diameter were resectable. The mean length of the segment involved in the resectable veins was significantly shorter than that of the unresectable veins. CONCLUSION: A non-operative treatment is recommended when vascular encasement exceeds 270degree in the veins or 180 degree in the arteries, when the arteries show narrowing, or when the veins show narrowing more than 2/3 of the original diameter. A curative resection should be attempted when the vascular encasement reaches < 180degree and when the arterial narrowing is absent.

Nonoperative management strategy to prevent the conversion of mild into severe acute pancreatitis / 中国普通外科杂志

Objective To discuss the nonoperative management strategy to prevent the conversion of acute pancreatitis to the severe form.Methods In recent 4 years,286 patients with mild acute pancreatitis admitted to our hospital were divided into control group and treatment observation group;routine conservative management was performed in control group,and the strategy of improving pancreatic microcirculation and preventing cell Ca~2+ overload and inhibiting pancreatic protease was added to the treatment observation group.Results Among the 144 patients with mild acute pancreatitis in control group,conversion to severe acute pancreatitis occurred in 20 patients,and 14 of the 20 patients with severe acute pancreatitis developed systemic complications.Among the 142 cases in treatment observation group,the conversion of mild to severe acute pancreatitis occurred in 8 patients,and 2 of the 8 patients developed systemic complications.Serum C-reactive protein levels and Balthazar CT severity index were significantly decreased at each time point in treatment observation group compared to control group.Conclusions In addition to routine management,improving pancreatic microcirculation,preventing cell Ca~2+ overload and inhibiting pancreatic protease might serve as a benificial strategy for preventing the progression of mild acute pancreatitis to the severe form.

Surgical treatment for patients with postpancreatic vascular invasion by pancreatic head carcinoma / 中国普通外科杂志

Objective To study the method of surgical treatment for patients with postpancreatic vascular invasion by pancreatic head carcinoma. Methods 25 patients with pancreatic head cancer and 1 with recurrent duodenal carcinoma with postpancreatic vessels involved by malignancy were treated by radical pancreatoduodenectomy with involved vascular resection(RPDIVR). Results There was no operation death in the 26 patients.Of the 26 cases, 4 had pancreatic fistula and 2 bile fistula postoperatively, but no vascular complication occurred. All of the 26 patients were followed up for 2.5-6.5 years( median time 4.5 years) and the average survival time was 56 months with 96.1%,88.4%, and 57.5% of 1,3,5 year survival rate. Coclusions (1)Colour Dopper imaging is a more useful and practical method in the preoperative examination of the vessels involved by malignancy. (2)When the postpancreatic vessels are involved by pancreatic head carcinoma, the rational treatment is RPDIVR. RPDIVR is a useful, safe, and an effective method and can improve the 5 year survival.