Radiologic Resectability Assessment in Pancreatic Cancer Radiologische Einschätzung der Resektabilität beim Pankreaskarzinom

Although notable progress in diagnosis and therapy has been made in recent years, the 5-year survival of patients diagnosed with ductal adenocarcinoma of the pancreas is still less than 5% [1]. To date, surgery is the only curative option for patients suffering from this aggressive entity. Nowadays in high-volume centers, this procedure can be performed with a mortality of 1–3% and morbidity of about 40% [2]. However, only a minority of patients is resectable and 5-year survival rates of more than 20% after resection are rare [2]. Radical resection of the tumor reaching negative resection margins is one of the strongest predictors for long-term survival [3]. Surgical exploration is the gold standard to determine unresectability. However, it is crucial to avoid passing the point of no return during explorative surgery. Otherwise, the resection has to be completed with the result of an R2-resection which implicates perioperative risk and does not improve prognosis [4]. Therefore, radiological assessment of resectability is an indispensible standard procedure before surgery with the goal to plan surgery by displaying the critical zones or to identify clearly unresectable patients. Surgical techniques have evolved significantly over the recent decades with attempts of more aggressive and radical resection. This is paralleled by technical advances in imaging technology regarding computed tomography (CT) and magnetic resonance imaging (MRI), which are the radiological modalities most frequently requested by surgeons for preoperative diagnostics and resectability assessment [5–7]. Therefore, a continuous Übersicht 23