Is CT angiography sufficient for prediction of resectability of periampullary neoplasms

The optimal preoperative evaluation of periampullary neoplasms remains cont roversial. The aim of this study was to analyze the accuracy of helical com puted tomography (CT) and CT angiography with three-dimensional reconstruct ion ill predicting resectability. Between March 1996 and May 1999, a total of 100 patients with periampullary neoplasms were prospectively staged by h elical CT and CT angiography with three-dimensional reconstruction. Vascula r involvement was graded from 0 to 4, with grade 0 representing no vascular involvement and grade 4 total encasement of either the superior mesenteric vein or artery. Patients with grade if lesions were considered unresectabl e. Sixty eight patients underwent surgical exploration with intent to perfo rm a pancreaticoduodenectomy. Forty-four lesions were grade 0, five were gr ade 1, eight were grade 2, and 11 were grade 3. Resectability for grades 0 to 3 was 96%, 100%, 50%, and 9%, respectively, for an overall resectability rate of 76%. Resectability in patients with vascular encroachment: (grade 2) is usually determined by the extent of local disease rather than the pre sence of extrapancreatic disease. Resection is rarely possible in patients with evidence of vascular encasement (grade 3). Additional imaging modaliti es such as diagnostic laparoscopy are superfluous in patients with no evide nce of local vascular involvement on CT angiography (grades 0 and 1) becaus e of the high resectability rate and infrequency of unsuspected distant met astatic deposits.