Assessment of the Interface Between Retroperitoneal Fat Infiltration of Pancreatic Ductal Carcinoma and the Major Artery by Multidetector-Row Computed Tomography: Surgical Outcomes and Correlation with Histopathological Extension
World Journal of Surgery,  Clinical Article

Yamamoto Y et al. – The grading criteria for retroperitoneal fat infiltration may be useful as a predictor of survival after pancreaticoduodenectomy for pancreatic head carcinoma. Pancreaticoduodenectomy with portal vein resection could provide favorable survival in patients with grade 1 retroperitoneal fat infiltration, even if histopathological portal vein invasion is present.

Methods
  • The clinical records of 132 patients who underwent macroscopic curative pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas between 2004 and 2008 were retrospectively examined.
  • The clinicopathological factors, including retroperitoneal fat infiltration classified into four groups by multidetector–row computed tomography (MDCT), were analyzed.
  • The relationship between the grade of retroperitoneal fat infiltration and surgical outcomes, as well as various histopathological factors, was also investigated.

Results
  • The 5 year survival rate was 55.6 % for grade 0 infiltration (n = 8), 38.7 % for grade 1 (n = 54), 16.4 % for grade 2 (n = 49), and 0 % for grade 3 (n = 21).
  • There were significant differences in survival in each group.
  • Extrapancreatic nerve invasion and the surgical margin status were significantly associated with retroperitoneal fat infiltration demonstrated on MDCT.
  • According to the grading classification among the 43 patients with pathological portal vein invasion, the 5 year survival rate was 45.9 % for patients with grade 1, which was significantly better survival that those with grade 2 (P = 0.007).

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