| 1 | Computed tomography in diagnosing vascular invasion in pancreatic and periampullary cancers: a systematic review and meta-analysis显示文摘BACKGROUND: Preoperative diagnosis of local vascular invasion is very important to the selection of therapeutic protocols and prediction of the prognosis of pancreatic and periampullary cancers. This meta-analysis was designed to evaluate the accuracy of computed tomography (CT) in diagnosing vascular invasion in patients with pancreatic and periampullary cancers. DATA SOURCES: English-language articles reporting diagnostic accuracy of CT for vascular invasion in pancreatic and periampullary cancers were searched from the MEDLINE and PubMed databases. A meta-analysis was conducted to estimate pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. RESULTS: Data were extracted from 18 studies that met the inclusion criteria. The pooled sensitivity and specificity of CT in diagnosing vascular invasion were 77% and 81%. Since CT technology improved in different periods, in the recent five years (2004-2008) CT has shown a higher diagnostic accuracy, and the pooled sensitivity and specificity increased to 85% and 82%, respectively. Subgroup analysis of CT studies was made to determine the involvement of different vessels, and the pooled sensitivities for the invasion of the venous system, portalvein, and arterial system were 75%, 75%, and 68%, and the pooled specificities were 84%, 91%, and 92%, respectively. For CT imaging with vascular reconstruction, the pooled sensitivity and specificity were 84% and 85%, higher than the estimates in studies without reconstruction. CONCLUSIONS: Developed CT technology with vascular reconstruction is used as an imaging modality for diagnosing vascular invasion at present. Further combined application of various imaging modalities may improve the accuracy of diagnosis, especially for smaller vessel involvement, such as the superior mesenteric vein or artery, which are difficult to demarcate. | Zhao, Wen-Yi Luo, Meng Sun, Yong-Wei Xu, Qing Chen, Wei Zhao, Gang Wu, Zhi-Yong | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，5： | 7 |
| 2 | Pancreaticoduodenectomy with early superior mesenteric artery dissection显示文摘BACKGROUND:Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive human tumors.At present,surgical resection is the only potentially curative treatment.Early neck division is inadequate when invasion of the superior mesenteric artery(SMA)is suspected or in cases of replaced or accessory right hepatic artery.Malignant periampullary tumors often invade retroperitoneal peripancreatic tissues and a positive resection margin is associated with a poor long-term survival. DATA SOURCES:English-language medical databases,PubMed, ELSEVIER and SPRINGERLINK,were searched for articles on'posterior approach pancreaticoduodenectomy','superior mesenteric artery first approach','retroperitoneal tissue', 'hanging maneuver',and related topics. RESULTS:The modification allowed the surgeon to early identify the nonresectability of a replaced right hepatic artery if present,enabling complete dissection of the right side of the SMA and portal vein as well as complete excision of the retroportal pancreatic lamina. CONCLUSION:Pancreaticoduodenectomy with early retro-pancreatic dissection is a useful and safe technical variant, which is indicated for the improvement of the safety and curative effect of the procedure. | Xu, Yu-Fei Liu, Zuo-Jin Gong, Jian-Ping | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，6： | 4 |
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