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| Borderline resectable pancreatic tumors: Is there a need for further refinement of this stage? |
| Shailesh V Shrikhande, Supreeta Arya, Savio George Barreto, Sachin Ingle, Melroy A D Souza, Rohini Hawaldar and Parul J Shukla |
Mumbai, India
Author Affiliations: Department of Hepato-Pancreato-Biliary Surgical Oncology (Shrikhande SV, Ingle S, D Souza MA and Shukla PJ), Department of Radiology (Arya S), and Clinical Research Secretariat (Hawaldar R), Tata Memorial Hospital, Mumbai, India; Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia (Barreto SG)
Corresponding Author: Shailesh V Shrikhande, Professor and Consultant Surgeon, Department of Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai 400 012, India (Tel: +91-22-24177173; Fax: +91-22-24148114; Email: shailushrikhande@hotmail.com, shailesh.shrikhande@pancreaticcancerindia.org) |
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Abstract BACKGROUND: The ideal treatment of patients with "borderline resectable pancreatic tumors (BRTs)" needs to be established. Current protocols advise neoadjuvant chemo(radio)therapy, although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection. The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection, with or without vascular resection (VR), could be achieved.
METHODS: Twelve patients with BRTs were identified. Tumor location, maximum degree of circumferential contact (CC), length of contact of the tumor with major vessels (LC), and luminal narrowing of vessels at the point of contact with the tumor (venous deformity, VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR.
RESULTS: A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin. Four of the 10 patients required VR (40%). In 3 of the 4 patients whose tumors required VRs, CC was ≥grade III and VD was grade 2. LC did not influence the need for VR.
CONCLUSIONS: It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging. Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients, thus avoiding any delay in curative resections in such patients.
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2011, Vol. 10 
