Value of multidetector computed tomographic angiography in marginally resectable pancreatic cancer

Dimitris Fagkrezos,1 Christos Dervenis,2 Charikleia Triantopoulou11Radiology Department, 2Department of Surgery, Konstantopouleio Hospital Neas Ionias, Athens, Greece Background: Pancreatic carcinoma is a common gastrointestinal malignancy. Accurate preoperative imaging helps to avoid unnecessary or unsuccessful surgical procedures and reduce the number of aborted pancreatic resections. The purpose of this review is to determine the role of multidetector computed tomographic angiography (MDCTA), which allows rapid anatomic evaluation, in accurate local and distant staging of marginally resectable pancreatic adenocarcinomas. Methods: Our methodology was based on the systematic search of published papers using PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for the years 2009–2014, reporting on the reliability and diagnostic accuracy of MDCTA in the evaluation of pancreatic cancer resectability. Results: Based on 33 articles analyzed in the review, MDCTA is the most widely available imaging modality for diagnosing and staging patients with pancreatic cancer, and it can be used for the surgical planning, specifically in locally advanced marginally resectable tumors. Conclusion: Accurate pretreatment assessment of resectability is crucial to design appropriate preoperative protocols of the operating team. It is possible to achieve a complete resection at the first instance in some patients who have borderline resectable tumors as predicted on preoperative imaging. Preoperative MDCTA-based grading systems can help identify such patients. This would help to avoid delayed curative resections in such patients and minimize the risk of aborted open–close operations. Keywords: MDCTA, MDCT angiography, borderline resectable tumors