Adenocarcinoma of the head of the pancreas: Determination of surgical unresectability with thin-section pancreatic-phase helical CT

OBJECTIVE. This study was conducted to evaluate newly introduced criteria f or unresectability of pancreatic cancer with thin-section pancreatic-phase helical CT. MATERIALS AND METHODS. Twenty-five patients with adenocarcinoma in the head of the pancreas underwent thin-section pancreatic-phase helical CT. The ma jor peripancreatic vessels were categorized on a scale of 1-4, according to the degree of circumferential involvement by tumor. The maximum diameters of the small peripancreatic veins-gastrocolic trunk, anterosuperior pancrea ticoduodenal vein, and posterosuperior pancreatidoduodenal vein-were record ed. Findings on CT were compared with the results of surgery in each patien t. RESULTS. Sixteen patients had surgically resectable tumors, and nine patien ts had surgically unresectable tumors. CT and surgical correlation was avai lable for 98 major peripancreatic vessels; 85 were resectable and 13 were u nresectable. Of category 1 vessels, 72 (97%) of 74 were resectable at surge ry. Of category 2 vessels, 12 (71%) of 17 were resectable. One (50%) of two category 3 vessels and none (0%) of five category 4 vessels were resectabl e at surgery. CT showed a dilated gastrocolic trunk in two patients; one of these patients had a surgically resectable tumor, but the other patient ha d a surgically unresectable tumor. CONCLUSION. In patients with adenocarcinoma in the head of the pancreas, th e degree of circumferential vessel involvement by tumor as shown by CT is u seful in predicting which patients will have surgically unresectable tumors . A dilated gastrocolic trunk should not be used as an independent sign of surgical unresectability.