Vascular invasion is key for determining resectability of pancreatic cancers, absent metastatic disease, explained Dr. Supreeta Arya. So-called borderline resectable cases may sometimes be downstaged with neoadjuvant chemotherapy and radiotherapy before surgery, and the criteria depend on the tumor-vascular relationship at CT. Currently, there are several definitions of borderline resectable depending on the degree of circumferential contact between vessel and tumor, but no uniform consensus exists for venous involvement.
The study retrospectively analyzed images from 15 patients who underwent Whipple surgery, examining tumor location, size, and relationship to main portal vein and superior mesenteric vein. The group analyzed several parameters involving luminal narrowing and tumor-vessel contact, along with the surgical results.
Resection was completed in 13 patients, while two had microscopic positive margins on histopathology, the group reported.
"Our observations identified features that could help rule out or predict definitive venous involvement," according to Arya. "We believe that our observations can help refine the definition of borderline resectable pancreatic adenocarcinomas with respect to venous invasion."
