Efficacy of multi-detector computerized tomography scan, endoscopic ultrasound, and laparoscopy for predicting tumor resectability in pancreatic adenocarcinoma

Abstract

Background: Definitive treatment for pancreatic adenocarcinoma is surgical resection. Endoscopic ultrasound (EUS), multi-detector computerized tomography scan (MDCT), and laparoscopy are current preoperative methods for assessing the resectability in this malignancy. This study compared the efficacy of these methods in predicting the resectability of pancreatic adenocarcinoma.

Methodology: One hundred and fifty-seven patients considered for resection of pancreatic adenocarcinoma in two centers in Iran were evaluated. All of the patients were evaluated by MDCT and/or EUS; ones that had resectable tumor in imaging were assessed by laparoscopy/laparotomy. Patients undergoing pancreaticoduodenectomy were followed for 2 years.

Results: The majority (67%) were male. The mean age was 66 years. The lesion was situated in the head of pancreas in 127 cases (81%). Tumor resectability rate according to the MDCT scan/EUS, laparoscopy, and laparotomy was 6%, 5%, and 3%, respectively. Only 3% of the pancreatic adenocarcinoma cases were resectable at the time of diagnosis. Fifty percent of patients predicted to have resectable tumor according to MDCT/EUS and 37.5% of cases that had resectable disease in laparoscopy were found to have unresectable lesions at laparotomy and or postsurgical follow up.

Conclusions: Prognosis continues to be dismal for pancreatic adenocarcinoma, and better methods to assess tumor resectability are needed.