[Resectability of papillary and pancreatic cancer assessed by ultrasonography and computer tomography]

A retrospective study of 65 patients with postoperatively verified pancreatic or peripancreatic cancer was conducted. Before surgery all patients had ultrasonography (US) performed, and 46 patients had computed tomography (CT) performed as well. After operation description of pre-operative radiological findings has been compared to description of operative and pathological findings. Three of the 65 patients were excluded either because of lacking radiological descriptions (two patients) or uncertain operative findings (one patient). When both investigations were performed, they were carried out independently by two skilled radiologists without knowledge of the result of the other investigations. The following criteria were used for non-resectability encasement of splanchnic vessels, liver metastases, peritoneal thickening with ascites, and glandular enlargement. As assessed by US, 15 of 16 (94%) were truly predicted to be non-resectable, whereas only 21 of 38 (55%) were truly predicted resectable. CT was performed in 46 patients of which 19 of 21 (90%) were truly predicted non-resectable, and 17 of 21 (81%) were truly predicted resectable. It was not possible to perform a conclusive radiological investigation in eight of 62 (13%) cases by US, and four of 46 (9%) cases by CT. One patient was falsely predicted non-resectable by US and an additional one by CT. Both were falsely predicted non-resectable on suspicion of vessel involvement. Overall, invasion of vessels was the most common cause for non-resectability, at the same time this was the index of non-resectability that was most often not detected pre-operatively. US is reliable when predicting non-resectability. When resectable tumour is detected by US, supplementary investigations such as CT should be applied, and when necessary endoscopic procedures or laparoscopy as well. Hereby unnecessary laparotomies may be avoided. Care should be taken when suspecting papillary tumour; only 66% of these were detected by either of the two methods.