Journal of Clinical Practice · Published 2026-06-15 · DOI 10.17816/clinpract704885
Denis M. Kuchin, Grigory A. Yarikhovich, Alexander V. Smirnov, Yan I. Kolesnik, Vladimir E. Zagainov
BACKGROUND: Evaluation of true venous invasion in pancreatic cancer using preoperative computed tomography data plays a key role in determining tumor resectability, choosing treatment strategies, and planning the extent of surgical intervention. With the widespread use of neoadjuvant chemotherapy, traditional computed tomography criteria for venous involvement developed for chemotherapy-naive patients may lose diagnostic reliability due to significant post-therapy fibrotic changes. AIM: To analyze the diagnostic capabilities of preoperative computed tomography in detecting true venous invasion of the portal system in patients with pancreatic cancer after neoadjuvant chemotherapy. METHODS: A retrospective analysis of 61 patients with pancreatic head cancer who underwent radical surgery was conducted. Patients were divided into two groups: 37 patients without preoperative drug therapy and 24 patients who received neoadjuvant polychemotherapy. Preoperative computed tomography data were used to assess the angle of circumferential tumor contact with the portal veins, the length of contact, and the nature of the vascular wall contour (the presence or absence of erosion). Histological examination of resected venous wall sections served as the reference method. RESULTS: Irregularity of the venous wall contour or tumor coverage of more than 180° of the main venous vessels were associated with a high rate of true venous invasion. However, the absence of erosion and contact of less than 180° did not exclude tumor growth into the venous wall. A significant proportion (24.3%) of patients classified as resectable ultimately had morphologically confirmed invasion. In patients after neoadjuvant chemotherapy, none of the pre- or post-treatment computed tomography findings reliably predicted the presence or absence of true venous invasion. Increasing the number of courses of neoadjuvant chemotherapy to more than five was associated with a significant reduction in the incidence of true venous invasion. CONCLUSION: After neoadjuvant chemotherapy, the diagnostic value of preoperative computed tomography in assessing true venous invasion in pancreatic cancer is significantly reduced. Even in the absence of vein contour irregularities and limited tumor-vessel contact, a clinically significant probability of tumor growth into the venous wall remains. On the other hand, in the presence of extensive contact and vascular wall irregularities, true vascular invasion may be absent. Computed tomography findings in the post-neoadjuvant group cannot be considered a reliable basis for refusing a patient surgical treatment.
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Kuchin, D., Yarikhovich, G., Smirnov, A., et al. (2026). COMPUTED TOMOGRAPHY AS A METHOD FOR DIAGNOSING TRUE VASCULAR INVASION IN PANCREATIC CANCER. Journal of Clinical Practice. https://doi.org/10.17816/clinpract704885