Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment?
<b>Summary:</b> The rates of microscopic incomplete resections (R1/R0CRM+) in patients receiving standard pancreaticoduodenectomy for PDAC remain very high. One reason may be the reported high rates of mesopancreatic fat infiltration. In this large cohort study, we used available histopa...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-08-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/13/17/4361 |
| _version_ | 1797521626859831296 |
|---|---|
| author | Sami-Alexander Safi Lena Haeberle Sophie Heuveldop Patric Kroepil Stephen Fung Alexander Rehders Verena Keitel Tom Luedde Guenter Fuerst Irene Esposito Farid Ziayee Gerald Antoch Wolfram Trudo Knoefel Georg Fluegen |
| author_facet | Sami-Alexander Safi Lena Haeberle Sophie Heuveldop Patric Kroepil Stephen Fung Alexander Rehders Verena Keitel Tom Luedde Guenter Fuerst Irene Esposito Farid Ziayee Gerald Antoch Wolfram Trudo Knoefel Georg Fluegen |
| author_sort | Sami-Alexander Safi |
| collection | DOAJ |
| description | <b>Summary:</b> The rates of microscopic incomplete resections (R1/R0CRM+) in patients receiving standard pancreaticoduodenectomy for PDAC remain very high. One reason may be the reported high rates of mesopancreatic fat infiltration. In this large cohort study, we used available histopathological specimens of the retropancreatic fat and correlated high resolution CT-scans with the microscopic tumor infiltration of this area. We found that preoperative MDCT scans are suitable to detect cancerous infiltration of this mesopancreatic tissue and this, in turn, was a significant indicator for both incomplete surgical resection (R1/R0CRM+) and worse overall survival. These findings indicate that a neoadjuvant treatment in PDAC patients with CT-morphologically positive infiltration of the mesopancreas may result in better local control and thus improved resection rates. Mesopancreatic fat stranding should thus be considered in the decision for neoadjuvant therapy. <b>Background:</b> Due to the persistently high rates of R1 resections, neoadjuvant treatment and mesopancreatic excision (MPE) for ductal adenocarcinoma of the pancreatic head (hPDAC) have recently become a topic of interest. While radiographic cut-off for borderline resectability has been described, the necessary extent of surgery has not been established. It has not yet been elucidated whether pre-operative multi-detector computed tomography (MDCT) staging reliably predicts local mesopancreatic (MP) fat infiltration and tumor extension. <b>Methods:</b> Two hundred and forty two hPDAC patients that underwent MPE were analyzed. Radiographic re-evaluation was performed on (1) mesopancreatic fat stranding (MPS) and stranding to peripancreatic vessels, as well as (2) tumor diameter and anatomy, including contact to peripancreatic vessels (SMA, GDA, CHA, PV, SMV). Routinely resected mesopancreatic and perivascular (SMA and PV/SMV) tissue was histopathologically re-analyzed and histopathology correlated with radiographic findings. A logistic regression of survival was performed. <b>Results:</b> MDCT-predicted tumor diameter correlated with pathological T-stage, whereas presumed tumor contact and fat stranding to SMA and PV/SMV predicted and correlated with histological cancerous infiltration. Importantly, mesopancreatic fat stranding predicted MP cancerous infiltration. Positive MP infiltration was evident in over 78%. MPS and higher CT-predicted tumor diameter correlated with higher R1 resection rates. Patients with positive MP stranding had a significantly worse overall survival (<i>p</i> = 0.023). <b>Conclusions:</b> A detailed preoperative radiographic assessment can predict mesopancreatic infiltration and tumor morphology and should influence the decision for primary surgery, as well as the extent of surgery. To increase the rate of R0CRM− resections, MPS should be considered in the decision for neoadjuvant therapy. |
| first_indexed | 2024-03-10T08:15:12Z |
| format | Article |
| id | doaj.art-f76c86d402c94df29c3b0250be71fd1b |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T08:15:12Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-f76c86d402c94df29c3b0250be71fd1b2023-11-22T10:26:14ZengMDPI AGCancers2072-66942021-08-011317436110.3390/cancers13174361Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment?Sami-Alexander Safi0Lena Haeberle1Sophie Heuveldop2Patric Kroepil3Stephen Fung4Alexander Rehders5Verena Keitel6Tom Luedde7Guenter Fuerst8Irene Esposito9Farid Ziayee10Gerald Antoch11Wolfram Trudo Knoefel12Georg Fluegen13Department of General, Visceral, Thoracic and Pediatric Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyInstitute of Pathology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of General, Visceral, Thoracic and Pediatric Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of General, Visceral, Thoracic and Pediatric Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyInstitute of Pathology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of General, Visceral, Thoracic and Pediatric Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, GermanyDepartment of General, Visceral, Thoracic and Pediatric Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany<b>Summary:</b> The rates of microscopic incomplete resections (R1/R0CRM+) in patients receiving standard pancreaticoduodenectomy for PDAC remain very high. One reason may be the reported high rates of mesopancreatic fat infiltration. In this large cohort study, we used available histopathological specimens of the retropancreatic fat and correlated high resolution CT-scans with the microscopic tumor infiltration of this area. We found that preoperative MDCT scans are suitable to detect cancerous infiltration of this mesopancreatic tissue and this, in turn, was a significant indicator for both incomplete surgical resection (R1/R0CRM+) and worse overall survival. These findings indicate that a neoadjuvant treatment in PDAC patients with CT-morphologically positive infiltration of the mesopancreas may result in better local control and thus improved resection rates. Mesopancreatic fat stranding should thus be considered in the decision for neoadjuvant therapy. <b>Background:</b> Due to the persistently high rates of R1 resections, neoadjuvant treatment and mesopancreatic excision (MPE) for ductal adenocarcinoma of the pancreatic head (hPDAC) have recently become a topic of interest. While radiographic cut-off for borderline resectability has been described, the necessary extent of surgery has not been established. It has not yet been elucidated whether pre-operative multi-detector computed tomography (MDCT) staging reliably predicts local mesopancreatic (MP) fat infiltration and tumor extension. <b>Methods:</b> Two hundred and forty two hPDAC patients that underwent MPE were analyzed. Radiographic re-evaluation was performed on (1) mesopancreatic fat stranding (MPS) and stranding to peripancreatic vessels, as well as (2) tumor diameter and anatomy, including contact to peripancreatic vessels (SMA, GDA, CHA, PV, SMV). Routinely resected mesopancreatic and perivascular (SMA and PV/SMV) tissue was histopathologically re-analyzed and histopathology correlated with radiographic findings. A logistic regression of survival was performed. <b>Results:</b> MDCT-predicted tumor diameter correlated with pathological T-stage, whereas presumed tumor contact and fat stranding to SMA and PV/SMV predicted and correlated with histological cancerous infiltration. Importantly, mesopancreatic fat stranding predicted MP cancerous infiltration. Positive MP infiltration was evident in over 78%. MPS and higher CT-predicted tumor diameter correlated with higher R1 resection rates. Patients with positive MP stranding had a significantly worse overall survival (<i>p</i> = 0.023). <b>Conclusions:</b> A detailed preoperative radiographic assessment can predict mesopancreatic infiltration and tumor morphology and should influence the decision for primary surgery, as well as the extent of surgery. To increase the rate of R0CRM− resections, MPS should be considered in the decision for neoadjuvant therapy.https://www.mdpi.com/2072-6694/13/17/4361PDACmesopancreasfat strandingradiographic imagingMDCT |
| spellingShingle | Sami-Alexander Safi Lena Haeberle Sophie Heuveldop Patric Kroepil Stephen Fung Alexander Rehders Verena Keitel Tom Luedde Guenter Fuerst Irene Esposito Farid Ziayee Gerald Antoch Wolfram Trudo Knoefel Georg Fluegen Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment? Cancers PDAC mesopancreas fat stranding radiographic imaging MDCT |
| title | Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment? |
| title_full | Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment? |
| title_fullStr | Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment? |
| title_full_unstemmed | Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment? |
| title_short | Pre-Operative MDCT Staging Predicts Mesopancreatic Fat Infiltration—A Novel Marker for Neoadjuvant Treatment? |
| title_sort | pre operative mdct staging predicts mesopancreatic fat infiltration a novel marker for neoadjuvant treatment |
| topic | PDAC mesopancreas fat stranding radiographic imaging MDCT |
| url | https://www.mdpi.com/2072-6694/13/17/4361 |
| work_keys_str_mv | AT samialexandersafi preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT lenahaeberle preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT sophieheuveldop preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT patrickroepil preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT stephenfung preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT alexanderrehders preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT verenakeitel preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT tomluedde preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT guenterfuerst preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT ireneesposito preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT faridziayee preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT geraldantoch preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT wolframtrudoknoefel preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment AT georgfluegen preoperativemdctstagingpredictsmesopancreaticfatinfiltrationanovelmarkerforneoadjuvanttreatment |