Pankreas Adenokarsinomlarında Operabilitenin Belirlenmesinde Pankreatik Kanal Çapının Güvenilirliği

Year 2020, , 342 - 347, 30.09.2020

Abdussamet Batur , Fatma Durmaz

https://doi.org/10.16899/jcm.655932

Abstract

Amaç: Pankreas adenokarsinomlarının operabilitesini öngörmede pankreas kanalının çapını değerlendirmek.
Materyal-Metot: Histopatolojik olarak kanıtlanmış pankreas baş adenokarsinomu olan ve tanıdan önce nonspesifik semptomları nedeniyle multidetektör bilgisayarlı tomografi uygulanan 30 hastanın (21 erkek, 9 kadın; ort. yaş, 64.2 yıl; yaş aralığı 41-93 yıl) klinik ve görüntüleme bulgularını inceledik. Eşlik eden sekonder bulgular da analiz edildi.
Bulgular: Pankreas başı adenokarsinomu olan 30 hasta değerlendirildi. Bunlardan 13’ünün (% 43,3) operabl olduğu (A Grubu) ve 17'sinin (% 56,7) radyolojik ve cerrahi olarak inoperabl olduğu (B Grubu) bulundu. Grup A hastalarında dilate pankreas kanalının ortalama çapı 5.80 mm ve Grup B hastalarında 9.15 mm ölçüldü (p = 0.001). Pankreas kanalı çapının bez genişliğine oranı Grup A'da 0.46 ve Grup B'de 0.62 bulundu (p = 0.001). Koledok dilatasyonu, tümör büyüklüğü ve ilk başvuru şikayetleri gibi eşlik eden sekonder belirtiler iki grup arasında anlamlı bir farklılık göstermedi.
Sonuç: Ana pankreas kanalı çapı ve/veya kanal çapının bez genişliğine oranı, pankreas adenokarsinomlarının operabilitesini öngörmede faydalı olabilir.

Amaç: Pankreas adenokarsinomlarının
operabilitesini öngörmede pankreas kanalının çapını değerlendirmek.

Materyal-Metot: Histopatolojik olarak
kanıtlanmış pankreas baş adenokarsinomu olan ve tanıdan önce nonspesifik
semptomları nedeniyle multidetektör bilgisayarlı tomografi uygulanan 30
hastanın (21 erkek, 9 kadın; ort. yaş, 64.2 yıl; yaş aralığı 41-93 yıl) klinik
ve görüntüleme bulgularını inceledik. Eşlik eden sekonder bulgular da analiz
edildi.

Bulgular: Pankreas başı adenokarsinomu
olan 30 hasta değerlendirildi. Bunlardan 13’ünün (% 43,3) operabl olduğu (A
Grubu) ve 17'sinin (% 56,7) radyolojik ve cerrahi olarak inoperabl olduğu (B
Grubu) bulundu. Grup A hastalarında dilate pankreas kanalının ortalama çapı
5.80 mm ve Grup B hastalarında 9.15 mm ölçüldü (p = 0.001). Pankreas kanalı
çapının bez genişliğine oranı Grup A'da 0.46 ve Grup B'de 0.62 bulundu (p =
0.001). Koledok dilatasyonu, tümör büyüklüğü ve ilk başvuru şikayetleri gibi
eşlik eden sekonder belirtiler iki grup arasında anlamlı bir farklılık
göstermedi.

Sonuç: Ana pankreas kanalı çapı ve/veya
kanal çapının bez genişliğine oranı, pankreas adenokarsinomlarının
operabilitesini öngörmede faydalı olabilir.

Keywords

Biligisayarlı tomografi, Pankreatik adenokarsinom, Pankreatik kanal, Operabilite

The Reliability of Quantifying the Pancreatic Ductus in Predicting the Operability of Pancreatic Adenocarcinomas

Abstract

Purpose: To evaluate the quantifying of the pancreatic ductus in predicting the operability of pancreatic adenocarcinomas
Methods and Materials: We reviewed the clinical and imaging data of 30 patients (21 men, 9 women; mean age, 64.2 years; age range 41-93 years) who had histopathologically proven pancreatic head adenocarcinoma, and underwent multidetector CT for their initial nonspesific symptoms before the diagnosis was rendered. Accompanying secondary signs also were analysed.
Results: Thirty patients with pancreatic head adenocarcinoma were evaluated. Thirteen of them (43.3%) were found to be operable (Group A) and seventeen of them (56.7%) were found to be inoperable (Group B) radiologically and surgically. The mean caliber of the dilated pancreatic duct in Group A patients was 5.80 mm, and in Group B pateints was 9.15 mm (p=0.001). The ratio of pancreatic duct caliber to gland width was 0.46 in Group A and was 0.62 in Group B (p=0.001). Accompanying secondary signs such as choledoch dilatation, tumor size, and initial complaints showed no significant difference between the two groups.
Conclusion: The main pancreatic duct diameter and/or a ratio of duct to gland width can be useful in predicting the operability of pancreatic adenocarcinomas

Keywords

computed tomography, pancreatic adenocarcinoma, pancreatic duct, operability

References

• 1. Jemal A, Murray T, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics. CA Cancer J Clin. 2010;60(5):277.
• 2. Schima W, Ba-Ssalamah A, Kolblinger C, Kulinna-Cosentini C, Puespoek A, Gotzinger P. Pancreatic adenocarcinoma. Eur Radiol 2007; 17:638-649
• 3. Smith SL, Rajan PS. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol 2004;59:26-38
• 4. Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet 2004;363:1049-1057
• 5. Yoon SH, Lee JM, Cho JY, Lee KB, Kim JE, Moon SK, et al. Small pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology 2011; 259:442-452.
• 6. Tsuchiya R, Noda T, Harada N, Miyamoto T, Tomioka T, Yamamoto K, et al. Collective review of small carcinomas of the pancreas. Ann Surg 1986;203(1):77-81
• 7. Chiang KC, Yeh CN, Lee WC, Jan YY, Hwang TL. Prognostic analysis of patients with pancreatic head adenocarcinomas less than 2 cm undergoing resection. World J Gastroenterol. 2009;15(34):4305–10.
• 8. Deshmukh SD, Willmann JK, Jeffrey RB. Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. Am J Roentgenol. 2010;194:668–74.
• 9. Paspulati RM . Multidetector CT of the pancreas. Radiol Clin North Am 2005;43(6): 999-1020
• 10. Bluemke DA, Cameron JL, Hruban RH, Pitt HA, Siegelman SS, Soyer P, et al. Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 1995;197:381-385.
• 11. Lu DSK, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase thin- section helical CT. AJR Am J Roentgenol 1997;168:1439-1443.
• 12. Megibow AJ, Zhou XH, Rotterdam H, Francis IR, Zerhouni EA, Balfe DM, et al. Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability-report of the Radiology Diagnostic Oncology Group. Radiology 1995;195:327-332.
• 13. Luetmer PH, Stephens DH, Ward EM. Chronic pancreatitis: reassessment with current CT. Radiology 1989;171:353-357.
• 14. Ahn SS, Kim MJ, Choi JY, Hong HS, Chung YE, Lim JS. Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol 2009;19:2448-2455
• 15. Prokop M, Galanski M. Spiral and Multislice Computed Tomography of the Body. Thieme, Stuttgart New York 2003; 477-540
• 16. Karasawa E, Goldberg HI, Moss AA, Federle MP, London SS. CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis. Radiology 1983;148:489-493.
• 17. Li H, Zeng MS, Zhou KR, Jin DY, Lou WH. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr. 2005;29:170–175.
• 18. Gangi S, Fletcher JG, Nathan MA, Christensen JA, HarmsenWS, Crownhart BS, et al. Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. AJR Am J Roentgenol. 2004;82:897–90.
• 19. Plumley TF, Rohrmann CA, Freeny PC, Silverstein FE. Ball TJ. Double duct sign: reassessed significance in ERCP. AJR Am J Roentgenol 1982;138:31-35
• 20. Tanaka S, Nakaizumi A, Ioka T, Oshikawa O, Uehara H, Nakao M, et al. Main pancreatic duct dilatation: a sign of high risk for pancreatik cancer. Jpn J Clin Oncol 2002;32:407-411
• 21. Clark LR, Jaffe MH, Choyke PL, Grant EG, Zeman RK. Pancreatic imaging. Radiol Clin North Am 1985;23:489-501.
• 22. Freeny PC, Traverso LW, Ryan JA. Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 1993;165:600-606.
• 23. McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebremariam A. Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 2001;220: 97-102.
• 24. Schima W, Ba-Ssalamah A, K€olblinger C, Kulinna-Cosentini C, Puespoek A, Götzinger P. Pancreatic adenocarcinoma. Eur Radiol. 2007;17(3):638–649.
• 25. Paspulati RM. Multidetector CT of the pancreas. Radiol Clin North Am. 2005;43(6):999–1020.
• 26. Grieser C, Steffen IG, Grajewski L, Stelter L, Streitparth F, Schnapauff D, et al. Preoperative multidetector row computed tomography for evaluation and assessment of resection criteria in patients with pancreatic masses. Acta Radiol. 2010;51(10):1067–1077.
• 27. Lammer J, Herlinger H, Zalaudek G, Hofler H. Pseudotumorous pancreatitis. Gastrointest Radiol 1985;10:59-67.