Current Staging Systems for Pancreatic Cancer
From the *Division of Surgical Oncology, Department of Surgery, and †Departmentof Radiology, The Medical College of Wisconsin, Milwaukee, WI. The Cancer Journal
(Impact Factor: 4.24).
11/2012; 18(6):539-49. DOI: 10.1097/PPO.0b013e318278c5b5
Accurate pretreatment staging of pancreatic cancer is a crucial initial step in the development of a stage-specific treatment plan, either on- or off-protocol for any patient with pancreatic cancer. Importantly, current American Joint Committee on Cancer staging utilizes the maximal information available; if surgery has been performed, then pathological information from the resected specimen will provide additional information for both T and N staging. If surgery has not been performed, then staging is based on information from available cross-sectional imaging studies. Although American Joint Committee on Cancer staging was modified in the sixth edition to reflect the survival difference between patients with operable/resectable versus nonoperable/unresectable disease, the precise definitions of resectability continue to evolve. It is essential for clinicians of different specialties to understand the definitions of resectability to facilitate optimal patient care and to allow for accurate interpretation of the literature. This review focuses on important aspects of the pretreatment assessment of patients with particular attention to definitions of resectability. Computed tomography has become the optimal imaging modality for pancreatic cancer staging, but other adjunct studies, including endoscopic ultrasound and laparoscopy, may provide additional staging information especially in circumstances where computed tomography technology is limited. In addition, the process of a standardized pathological review is summarized, with emphasis on assessment of the superior mesenteric artery margin and the definitions of R0, R1, and R2. Finally, the prognostic importance of key components of the pathological report such as lymph node status, lymph node ratio, and treatment effect is reviewed.
Available from: scirp.org
- "Accurate pretreatment staging is essential for all solid tumor patients, but is particularly important in the management of pancreatic cancer. Pretreatment evaluations should be based on objective and reproducible anatomic definitions to avoid misclassification and incorrect treatment sequencing. Strict adherence to these criteria should be applied not only at initial staging but at serial evaluations to accurately assess treatment efficacy. "
Available from: link.springer.com
[Show abstract] [Hide abstract]
ABSTRACT: Complete tumor resection is still the only potentially curative therapy option for patients with ductal adenocarcinoma of the pancreas. Surgical exploration is the gold standard for the determination of tumor resectability. Radiological resectability assessment is of great importance because many clearly unresectable cases can be identified preoperatively and it became essential for surgical planning. The evolving surgical and radiological techniques demand a continuous reappraisal of radiological criteria in resectability assessment. In the following, the criteria for resection planning are described along with surgical management and the role of radiology in some innovative surgical concepts is explained.Citation Format:
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.