Radiological assessment of resectability status in patients with pancreatic cancer

Abstract

Introduction: Pancreatic adenocarcinoma is a major health concern as it is the third most common cause of cancer-related death. Surgery is the only curative option, but it is associated with a high rate of morbidity and mortality.

Objective: To accurately identify the patients with unresectable pancreatic cancer through the use of computed tomography imaging.

Material & Methods: This descriptive case series was conducted at Kuwait Teaching Hospital from July 2019 to June 2020. A total of 52 patients were evaluated with ages ranging from 11-90 years comprising 24 males and 28 females. CT scan abdomen with the pancreatic protocol was done on 16 slice Toshiba CT scanner in the Radiology department of Kuwait Teaching Hospital. Images were evaluated in axial, coronal and sagittal planes following pancreatic protocol. Data like patient age, gender, tumor location, size, venous and arterial involvement, lymph nodal and adjacent visceral involvement were collected and subjected to statistical analysis.

Results: Out of a total of 52 patients, pancreatic carcinoma was most prevalent in the head region which was observed in 35(67.3%) patients. The next common site was the uncinate process followed by the body and then the tail. In 57.7% the size of primary malignancy was more than 2 cm and in 42.3% of the patients, it was less than 2 cm. Superior Mesenteric Vein (SMV) was involved in pancreatic carcinoma in 7.7%, Inferior Vena Cava (IVC) in 3.8% and Portal Vein (PV) in 11.5% of the cases. The Celiac Artery was involved by the pancreatic tumor in 11.5% and Superior Mesenteric Artery (SMA) in 23.1% of the cases. Lymph nodal involvement was observed in 42.3% of the cases and adjacent visceral involvement was noted in 34.6% of the cases.

Conclusion: Pancreatic carcinoma was identified as surgically unresectable by CT scans in the majority of patients because of locally advanced disease having a size more than 2 cm, and with vascular, lymph nodal and adjacent visceral involvement.