Nerve plexus invasion on CT was linked to shorter survival, even in stage I pancreatic cancer

Design

Retrospective single-centre cohort with blinded double reading

Population

89 patients with resected pancreatic ductal adenocarcinoma and preoperative CT

Primary outcome

Overall survival by CT nerve plexus invasion

Effect

Invasion in 73%; associated with shorter survival overall and in stage I (P < 0.001)

This retrospective single-centre study had two blinded radiologists re-read the preoperative pancreatic protocol CT of 89 patients who went on to resection for pancreatic ductal adenocarcinoma, recording extra-pancreatic nerve plexus invasion by anatomical pathway and morphology.

Plexus invasion was seen on CT in 65 patients (73%) and was associated with shorter overall survival (P < 0.001), including in stage I tumours. Involvement of the PPC2 pathway — the plexus running from the uncinate process toward the superior mesenteric artery — and a mass-with-stranding pattern were each associated with worse survival, and both remained significant in stage I disease.

This gives the radiologist a reportable feature with prognostic weight that standard resectability criteria do not capture. The study is small and retrospective, and it does not show that reporting the finding changes treatment, but it supports describing plexus involvement explicitly when present.

• On pancreatic protocol CT, look for soft-tissue stranding along the peripancreatic nerve plexuses.
• Describe the pathway involved, particularly the plexus from the uncinate process towards the SMA.
• Distinguish fine stranding from a mass-with-stranding pattern, which was linked to worse survival.
• Report plexus involvement even in a tumour that otherwise looks stage I and resectable.

Why it matters

A small, apparently early tumour may carry a high-risk feature only the CT report can flag before surgery.

Don't overread it

A small retrospective series — it does not show that acting on this finding improves outcomes.

The statistics, in plain English

The P values show the survival differences were unlikely to be chance, but the abstract does not give hazard ratios, so the size of the effect is not stated. With 89 patients and several subgroups, some of these associations may not hold in a larger series.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.