Resectability of Pancreatic Cancer Is in the Eye of the Observer

Fabio Giannone, MD; Giovanni Capretti, MD; Mohammed Abu Hilal, MD, PhD; Ugo Boggi, MD; Donata Campra, MD; Carla Cappelli, MD; Riccardo Casadei, MD; Raffaele De Luca, MD; Massimo Falconi, MD; Gabriele Giannotti, MD; Luca Gianotti, MD; Roberto Girelli, MD; Paola Gollini, MD; Davide Ippolito, MD; Giorgio Limerutti, MD; Lorenzo Maganuco, MD; Valeria Malagnino, MD; Giuseppe Malleo, MD, PhD; Mario Morone, MD; Cristina Mosconi, MD; Federica Mrakic, MD; Diego Palumbo, MD; Roberto Salvia, MD, PhD; Salvatore Sgroi, MD; Alessandro Zerbi, MD; Gianpaolo Balzano, MD

doi:10.1097/AS9.0000000000000087

Annals of Surgery Open (Sep 2021)

Resectability of Pancreatic Cancer Is in the Eye of the Observer

Fabio Giannone, MD,
Giovanni Capretti, MD,
Mohammed Abu Hilal, MD, PhD,
Ugo Boggi, MD,
Donata Campra, MD,
Carla Cappelli, MD,
Riccardo Casadei, MD,
Raffaele De Luca, MD,
Massimo Falconi, MD,
Gabriele Giannotti, MD,
Luca Gianotti, MD,
Roberto Girelli, MD,
Paola Gollini, MD,
Davide Ippolito, MD,
Giorgio Limerutti, MD,
Lorenzo Maganuco, MD,
Valeria Malagnino, MD,
Giuseppe Malleo, MD, PhD,
Mario Morone, MD,
Cristina Mosconi, MD,
Federica Mrakic, MD,
Diego Palumbo, MD,
Roberto Salvia, MD, PhD,
Salvatore Sgroi, MD,
Alessandro Zerbi, MD,
Gianpaolo Balzano, MD

Affiliations

Fabio Giannone, MD: From the * Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
Giovanni Capretti, MD: † Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
Mohammed Abu Hilal, MD, PhD: § Department of Surgery, Hepato-pancreato-biliary Unit, Fondazione Poliambulanza, Brescia, Italy
Ugo Boggi, MD: ¶ Department of Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
Donata Campra, MD: # General Surgery and Emergency Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
Carla Cappelli, MD: ** Department of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
Riccardo Casadei, MD: †† Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna and Department of Internal Medicine and Surgery, Alma Mater Studiorum, University of Bologna, Bologna, Italy
Raffaele De Luca, MD: §§ Vita-Salute San Raffaele University, Milan, Italy
Massimo Falconi, MD: From the * Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
Gabriele Giannotti, MD: ∥∥ Department of Radiology, University of Verona Hospital Trust, Verona, Italy
Luca Gianotti, MD: ¶¶ School of Medicine and Surgery, Milano-Bicocca University and Department of Surgery, San Gerardo Hospital, Monza, Italy
Roberto Girelli, MD: ## Pancreatic Surgery Unit, “P. Pederzoli” Hospital, Peschiera del Garda, Verona, Italy
Paola Gollini, MD: *** Radiology and Neuroradiology Unit, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
Davide Ippolito, MD: ††† Department of Radiology, San Gerardo Hospital, Monza, Italy
Giorgio Limerutti, MD: ‡‡‡ Department of Radiology 2, AOU Città della Salute e della Scienza di Torino, Turin, Italy
Lorenzo Maganuco, MD: §§§ General Surgery Unit 2 and Pancreas Group, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
Valeria Malagnino, MD: ∥∥∥ Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II,” Bari, Italy
Giuseppe Malleo, MD, PhD: ¶¶¶ The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
Mario Morone, MD: ### Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
Cristina Mosconi, MD: **** Department of Radiology, Policlinico “S. Orsola Malpighi,” Bologna, Italy
Federica Mrakic, MD: †††† Department of Radiology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
Diego Palumbo, MD: ‡‡‡‡ Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
Roberto Salvia, MD, PhD: ¶¶¶ The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
Salvatore Sgroi, MD: §§§§ Department of Radiology, “P.Pederzoli” Hospital, Peschiera del Garda, Verona, Italy.
Alessandro Zerbi, MD: † Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
Gianpaolo Balzano, MD: From the * Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy

DOI: https://doi.org/10.1097/AS9.0000000000000087
Journal volume & issue: Vol. 2, no. 3
p. e087

Abstract

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Objectives:. To determine the reproducibility of the National Comprehensive Cancer Network (NCCN) resectability status classification for pancreatic cancer. Background:. The NCCN classification defines 3 resectability classes (resectable, borderline resectable, locally advanced), according to vascular invasion. It is used to recommend different approaches and stratify patients during clinical trials. Methods:. Prospective, multicenter, observational study (trial ID: NCT03673423). Main outcome measure was the interobserver agreement of tumor assignment to different resectability classes and quantification of vascular invasion degrees. Agreement was measured by Fleiss’ k (k = 1 perfect agreement; k = 0 agreement by chance). Sixty-nine computed tomography (CT) scans of pathologically confirmed pancreatic adenocarcinoma were independently reviewed in a blinded fashion by 22 observers from 11 hospitals (11 surgeons and 11 radiologists). Rating differences between surgeons or radiologists and between hospitals with different volumes (≥60 or 180° (k range: 0.619–0.756). Neither reviewers’ specialty nor hospital volume influenced the agreement. Conclusions:. There is high variability in the assignment to resectability categories, which may compromise the reliability of treatments recommendations and the evidence of trials stratifying patients in resectability classes. Criteria should be revised to allow a reproducible classification.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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