Does multidetector-row CT eliminate the role of diagnostic laparoscopy in assessing the resectability of pancreatic head adenocarcinoma? J. Ellsmere, 1,2 K. Mortele, 3 D. Sahani, 4 M. Maher, 4 V. Cantisani, 3 W. Wells, 3 D. Brooks, 5 D. Rattner 1,2 1 Department of Surgery, Massachusetts General Hospital, 15 Parkman St, Boston, MA 02114, USA 2 Centre for Integration of Medicine and Innovative Technology, Cambridge, MA 02138, USA 3 Department of Radiology, Brigham and WomenÕs Hospital, 75 Francis Street, Boston, MA 02115, USA 4 Department of Radiology, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA 5 Department of Surgery, Brigham and WomenÕs Hospital, 75 Francis Street, Boston, MA 02115, USA Received: 2 February 2004/Accepted: 29 September 2004/Online publication: 23 December 2004 Abstract Background: We hypothesized that the high-quality images from multidetector-row computed tomography (MDCT) would lead to improved sensitivity and speci- ficity for predicting resectable pancreatic head adeno- carcinoma, thus diminishing the value of staging laparoscopy. Methods: Forty four consecutive patients underwent thin-section dual-phase MDCT to stage their tumor, followed by an attempted pancreaticoduodenectomy. Four radiologists who were blinded to the operative outcome reviewed the scans and graded the presence of distant and nodal metastases, as well as the degree of arterial and portal involvement. The radiologic criteria for resectability were no distant metastasis, a patent portal vein, and <50% arterial involvement. Results: The overall resectability for this cohort was 52% (23/44). The 21 unresectable cases, included five liver metastases, three peritoneal metastases, and 13 locally invasive tumors. The negative margin resection rate was 34% (15/44). There were no portal vein resec- tions. The sensitivity and specificity of MDCT for pre- dicting resectability were 96% (22/23) and 33% (7/21), respectively. In this cohort, the positive and negative predictive values were 61% (22/36) and 87.5% (7/8), respectively. As determined by univariate logistic regression, only the degree of arterial involvement was a significant predictor of resectability (p = 0.02). As determined by multivariate logistic regression using both arterial and portal involvement, arterial involve- ment was predictive (p = 0.03) but portal vein involvement was not (p = 0.45). Conclusions: Despite the improvements in image quality obtained with multidetector-row technology, CT imag- ing remains a relatively nonspecific test for predicting resectability in patients with adenocarcinoma of the head of the pancreas. Minimally invasive modalities with higher specificity, particularly laparoscopy, con- tinue to have an important role in staging pancreatic head adenocarcinoma. Key words: Pancreatic head adenocarcinoma — Stag- ing — Resectability — Accuracy The search for ways to improve the staging of pancreatic head adenocarcinoma continues to be an active area of clinical research. Pancreatic cancer is the fourth leading cause of cancer death in North America. The only potentially curative therapy is surgery. Because of the morbidity and possible mortality associated with a curative resection, it is important to differentiate those individuals who are likely benefit from surgery from those who are unlikely to benefit. Most research on improving staging has focused on using various combi- nations of preoperative, endoscopic, and intraoperative modalities. In practice, the most commonly used strat- egy is CT, followed by surgical exploration [7]. The positive predictive value of CT for predicting resectable pancreatic head adenocarcinoma lies some- where between 50% and 80% [1–3, 9, 10]. Advances in CT technology are likely partially responsible for this variation. Over the last decade, the quality and speed of CT imaging has improved considerably, first with the aid of the helical scanner and more recently with mul- tidetector-row scanners. Alhough these advances have improved the quality of CT images, it is not clear how Correspondence to: D. Rattner Surg Endosc (2005) 19: 369–373 DOI: 10.1007/s00464-004-8712-5 Ó Springer Science+Business Media, Inc. 2004