August 1996

Assessment of Resectability of Pancreatic Head and Periampullary Tumors by Color Flow Doppler Sonography

Author Affiliations

From the Departments of Surgery (Drs Wren, Stain, Kasiraman, and Parekh), Radiology (Dr Ralls), and Preventive Medicine (Dr Carpenter), University of Southern California School of Medicine, Los Angeles.

Arch Surg. 1996;131(8):812-818. doi:10.1001/archsurg.1996.01430200022004

Objective:  To examine the sensitivity of color flow Doppler ultrasonography in assessing resectability of pancreatic head and periampullary tumors.

Design:  Validation cohort study.

Setting:  Tertiary care public hospital.

Patients:  Thirty-seven patients with pancreatic head or periampullary cancer were studied by color flow Doppler examination of the relevant blood vessels.

Main Outcome Measure:  A pancreatic Doppler score (PDS) was defined as the closest circumferential contact of the tumor to the superior mesenteric vein, superior mesenteric artery, or portal vein. A PDS of 1 indicated no contact (n=9); PDS 2, less than 50% contact (n=10); PDS 3, 50% to 99% contact (n=7); and PDS 4, encasement (n=11). The PDS was compared with operative and histologic resection margins.

Results:  The lack of vascular invasion was confirmed operatively in 7 of 7 patients with a PDS of 1, and 6 patients who underwent resection had clear histologic margins. Nine (90%) of 10 patients with a PDS of 2 were confirmed to have no vascular invasion, and 3 (43%) of 7 patients who underwent resection had clear margins. Five (83%) of 6 patients with a PDS of 3 had correct operative findings, and both patients who underwent resection had positive margins. Operative confirmation of encasement was found in all 7 patients with a PDS of 4 who had operative exploration, and none underwent resection.

Conclusions:  Color flow Doppler sonography and PDS predicted resectability and the histologic margin status (positive predictive value, 97%). Patients with a PDS of 1 are predicted to have clear histologic margins after resection. Patients with a PDS of 4 have unresectable tumors, and nonoperative palliation should be considered. Patients with a PDS of 2 or 3 have a high likelihood of positive histologic margins after resection and may be candidates for neoadjuvant chemotherapy.Arch Surg. 1996;131:812-818