Thin-Slice Preoperative CT Recommended to Avoid Aborted Periampullary Carcinoma Surgery

Preoperative CT in patients with periampullary adenocarcinoma should include thin slices (< 2.5 mm) to decrease the likelihood of an unexpectedly aborted Whipple procedure, according to a study published in the American Journal of Roentgenology.

“Elevated serum CA 19-9 levels and preoperative CT using only slice thickness of 2.5 mm or more were associated with aborted curative-intent Whipple procedures,” wrote corresponding author Christian B. van der Pol, MD, FRCPC, an associate professor of radiology at McMaster University in Hamilton, Ontario, Canada. “Many other imaging and clinical factors did not show an association.”

Ten US, Canadian, and French institutions contributed data to this retrospective case-control study of 360 adults (220 men, 140 women; mean age, 68.6 years) with periampullary adenocarcinoma who underwent curative-intent Whipple procedures between January 2016 and December 2022. A total of 180 patients for whom the procedure was aborted (cases) were matched by sex and 5-year age blocks with 180 patients for whom the procedure was completed (controls). Covariates included cancer type, tumor size and resectability on CT, CT reconstruction slice thickness including by phase, number of phases, multiplanar imaging, reconstruction at the workstation, possible metastases reported, structured versus unstructured report, reporting radiologist’s experience, hepatic steatosis, preoperative liver MRI, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, multidisciplinary review, neoadjuvant therapy and response, and serum CA 19-9 and CEA levels.

Ultimately, for patients with periampullary adenocarcinoma, preoperative CT including only slice thicknesses of 2.5 mm or more and serum CA 19-9 levels of 37 U/mL or more were associated with aborted Whipple procedures (OR = 4.28 [95% CI, 1.37–15.00] and 3.75 [95% CI, 1.22–12.77], respectively).