Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge
<b>Background:</b> Assessing pancreatic ductal adenocarcinoma (PDAC) resectability after neoadjuvant therapy (NAT) remains a diagnostic challenge. Traditional computed tomography (CT) criteria often fail to distinguish viable tumor from fibrosis, necessitating a reassessment of imaging-b...
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MDPI AG
2025-07-01
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| author | Ioannis Christofilis Charikleia Triantopoulou Spiros Delis |
| author_facet | Ioannis Christofilis Charikleia Triantopoulou Spiros Delis |
| author_sort | Ioannis Christofilis |
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| description | <b>Background:</b> Assessing pancreatic ductal adenocarcinoma (PDAC) resectability after neoadjuvant therapy (NAT) remains a diagnostic challenge. Traditional computed tomography (CT) criteria often fail to distinguish viable tumor from fibrosis, necessitating a reassessment of imaging-based standards. <b>Methods:</b> A comprehensive literature review was conducted using PubMed, focusing on prospective and retrospective studies over the past 25 years that evaluated the role of CT and complementary imaging modalities (MRI, PET-CT) in predicting resectability post-NAT in non-metastatic PDAC. Studies with small sample sizes or case reports were excluded. <b>Results:</b> Across studies, conventional CT parameters—particularly >180° vascular encasement—showed a limited correlation with histologic invasion or surgical outcomes after NAT. Persistent vessel contact on CT often reflected fibrosis, rather than active tumor. Dynamic changes, such as regression in the tumor–vessel interface and vessel lumen restoration, correlated more accurately with R0 resection. Adjunct markers like CA 19-9 response and patient performance status further improved resectability prediction. <b>Conclusions:</b> CT-based resectability assessment after NAT should transition from static morphologic criteria to response-based interpretation. Multidisciplinary evaluation integrating radiologic, biochemical, and clinical findings is essential to guide surgical decision-making and improve patient outcomes. |
| format | Article |
| id | doaj-art-34e4843d530749258e6c83f4332e5d48 |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-34e4843d530749258e6c83f4332e5d482025-08-20T03:07:54ZengMDPI AGDiagnostics2075-44182025-07-011514181010.3390/diagnostics15141810Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging ChallengeIoannis Christofilis0Charikleia Triantopoulou1Spiros Delis2Radiology Department, Konstantopouleio Hospital, 142 33 Athens, GreeceRadiology Department, Konstantopouleio Hospital, 142 33 Athens, GreeceHPB Unit, Konstantopouleio Hospital, 142 33 Athens, Greece<b>Background:</b> Assessing pancreatic ductal adenocarcinoma (PDAC) resectability after neoadjuvant therapy (NAT) remains a diagnostic challenge. Traditional computed tomography (CT) criteria often fail to distinguish viable tumor from fibrosis, necessitating a reassessment of imaging-based standards. <b>Methods:</b> A comprehensive literature review was conducted using PubMed, focusing on prospective and retrospective studies over the past 25 years that evaluated the role of CT and complementary imaging modalities (MRI, PET-CT) in predicting resectability post-NAT in non-metastatic PDAC. Studies with small sample sizes or case reports were excluded. <b>Results:</b> Across studies, conventional CT parameters—particularly >180° vascular encasement—showed a limited correlation with histologic invasion or surgical outcomes after NAT. Persistent vessel contact on CT often reflected fibrosis, rather than active tumor. Dynamic changes, such as regression in the tumor–vessel interface and vessel lumen restoration, correlated more accurately with R0 resection. Adjunct markers like CA 19-9 response and patient performance status further improved resectability prediction. <b>Conclusions:</b> CT-based resectability assessment after NAT should transition from static morphologic criteria to response-based interpretation. Multidisciplinary evaluation integrating radiologic, biochemical, and clinical findings is essential to guide surgical decision-making and improve patient outcomes.https://www.mdpi.com/2075-4418/15/14/1810pancreatic cancerneoadjuvant therapycomputed tomographyresectabilityvascular involvementimaging biomarkers |
| spellingShingle | Ioannis Christofilis Charikleia Triantopoulou Spiros Delis Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge Diagnostics pancreatic cancer neoadjuvant therapy computed tomography resectability vascular involvement imaging biomarkers |
| title | Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge |
| title_full | Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge |
| title_fullStr | Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge |
| title_full_unstemmed | Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge |
| title_short | Pancreatic Cancer Resectability After Neoadjuvant Treatment: An Imaging Challenge |
| title_sort | pancreatic cancer resectability after neoadjuvant treatment an imaging challenge |
| topic | pancreatic cancer neoadjuvant therapy computed tomography resectability vascular involvement imaging biomarkers |
| url | https://www.mdpi.com/2075-4418/15/14/1810 |
| work_keys_str_mv | AT ioannischristofilis pancreaticcancerresectabilityafterneoadjuvanttreatmentanimagingchallenge AT charikleiatriantopoulou pancreaticcancerresectabilityafterneoadjuvanttreatmentanimagingchallenge AT spirosdelis pancreaticcancerresectabilityafterneoadjuvanttreatmentanimagingchallenge |