HPB, 2006; 8: 365-368.
Evans DB.
Evaluation of the potential value of nonsurgical therapies (chemotherapy and radiation therapy) in improving local disease control and survival of patients with pancreatic cancer requires accurate pretreatment staging (to define the study population) and a standardized system for the pathologic evaluation of surgical specimens (to determine the completeness of resection). This is routinely performed in most other solid tumors yet rarely completed in an organized fashion in pancreatic cancer, making the interpretation of the published literature difficult or impossible. For example, the definition of resectable pancreatic cancer used in most studies is based upon whether or not the surgeon has removed the pancreatic head, often with no system of margin analysis.
Multidetector (multislice) computed tomography (CT) is used to objectively define (anatomically) potentially resectable disease, borderline resectable disease, locally advanced disease, and metastatic disease. Although contrast-enhanced CT is widely available, accurate interpretation and reporting of the tumor-related findings remains inconsistent. For optimal pretreatment staging and assessment of oper-ability, a CT report in a patient with suspected periampullary or pancreatic cancer should include the following information: (1) commentary on the presence or absence of a primary tumor in the pancreas; (2) commentary on the presence or absence of peritoneal and hepatic metastases; (3) description of the patency of the superior mesenteric vein-portal vein confluence and the relationship of these veins to the tumor; (4) description of the relationship of the tumor to the superior mesenteric artery (SMA), celiac axis, and hepatic artery.