Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability

Figure 5 In this 61-year-old woman (case 6), 260° and 360° pancreatic ductal adenocarcinoma encasement of SMA segments was diagnosed on computed tomography (A-E), while endoUS data described only tumor abutment with the superior mesenteric artery. A, B: Venous phase. Sagittal view. Computed tomography provided evidence of circumferential involvement of the SMV and PV; C, E: Arterial phase. Sagittal view. The distal SMA segment (6-7 cm from the origin) presented circumferential adjacency to pancreatic head ductal adenocarcinoma. The celiac artery (CA) was unaffected; D: Arterial phase. Axial image. At least 260° of the proximal SMA segment (2.5-3 cm from the origin) was circumscribed by tumor. An extended Whipple procedure with pancreatic body, portal, splenic and superior mesenteric vein resection was performed with the use of a superficial femoral vein autograft (F, G). Notwithstanding “organoleptic” signs of unresectability (both hepatic arteries were embedded in the tumor) (F), there were no signs of superior mesenteric artery (SMA) or hepatic artery involvement during surgery (G). The level of resection was R1 because of the contact of the SMA with the tumor. A: Aorta; CHA: Common hepatic artery; RHA: Right hepatic artery; LHA: Left hepatic artery; SA: Splenic artery; SMV: Superior mesenteric; PV: Portal vein; LRV: Left renal veins; T: Tumor; Pancr: Pancreatic tail stump.