Review
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World J Gastroenterol. Feb 21, 2010; 16(7): 818-831
Published online Feb 21, 2010. doi: 10.3748/wjg.v16.i7.818
Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management
Nicolas C Buchs, Michael Chilcott, Pierre-Alexandre Poletti, Leo H Buhler, Philippe Morel
Nicolas C Buchs, Michael Chilcott, Leo H Buhler, Philippe Morel, Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, 1211, Switzerland
Pierre-Alexandre Poletti, Department of Radiology, University Hospitals of Geneva, Geneva, 1211, Switzerland
Author contributions: Buchs NC, Chilcott M, Poletti PA and Buhler LH wrote the paper; Buchs NC, Buhler LH and Morel P designed the study; Buchs NC, Buhler LH and Morel P performed the research.
Correspondence to: Dr. Nicolas C Buchs, MD, Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. nicolas.c.buchs@hcuge.ch
Telephone: +41-22-3727698 Fax: +41-22-3727689
Received: August 21, 2009
Revised: October 6, 2009
Accepted: October 13, 2009
Published online: February 21, 2010
Abstract

Pancreatic cancer is associated with a poor prognosis, and surgical resection remains the only chance for curative therapy. In the absence of metastatic disease, which would preclude resection, assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer. A frequent error is to misdiagnose an involved major vessel. Obviously, surgical exploration with pathological examination remains the “gold standard” in terms of evaluation of resectability, especially from the point of view of vascular involvement. However, current imaging modalities have improved and allow detection of vascular invasion with more accuracy. A venous resection in pancreatic cancer is a feasible technique and relatively reliable. Nevertheless, a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular invasion. Although the discovery of an arterial invasion during the operation might require an aggressive management, discovery before the operation should be considered as a contraindication. Detection of vascular invasion remains one of the most important challenges in pancreatic surgery. The aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.

Keywords: Vascular invasion; Cancer; Pancreas; Management