Preoperative 3D Imaging Reconstruction Models for Predicting Infiltration of Major Vascular Structures in Patients During Pancreatic Surgery

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Introduction Vascular infiltration is the main limitation of resectability in locally advanced pancreatic cancer; thus, an accurate preoperative study is mandatory to plan an appropriate surgical strategy. In recent years, medical image fusion and three-dimensional reconstruction models have gained acceptance in general surgery, especially in the hepatic field. In pancreatic pathology, 3D reconstruction also may improves preoperative staging. The study aim was to compare the performance of a 3D imaging reconstruction model with that of conventional computed tomography (CT), and magnetic resonance imaging (MRI) for evaluating infiltration of major vascular structures in patients planning to undergo upfront pancreatic surgery. Materials and Methods Patients with pancreatic cancer who underwent upfront surgical resection at Sanchinarro University Hospital from May 2018–June 2023 were retrospectively reviewed. The performance of a preoperative 3D reconstruction with the 3D Cella Medical Solutions (3D-MSP ® ) model was compared with that of traditional CT and MRI imaging. Results Three of 34 patients who underwent upfront pancreatic surgery with 3D reconstruction required vascular resection. For both venous and arterial involvement, 3D imaging demonstrated superior diagnostic accuracy, achieving 100% sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. Compared with CT and MRI, 3D reconstruction significantly improved specificity and the PPV, which enhanced preoperative vascular staging and surgical planning. Conclusion Preoperative determination of vascular involvement was significantly better for 3D imaging reconstruction than for the other tested methods in patients with pancreatic cancer.

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