The International Association of Pancreatology (IAP) criteria for 'borderline resectable' pancreatic head cancer include which vascular parameter?

• A Tumour contact with the superior mesenteric artery >270° circumference (arterial encasement)
• B Tumour abutment (≤180°) of the superior mesenteric artery, or short-segment involvement/abutment of the hepatic artery, or short-segment involvement of the superior mesenteric vein/portal vein amenable to reconstruction ✓
• C Distant lymph node metastasis beyond the standard resection field
• D Tumour extension to the coeliac axis with >270° encasement

Explanation

Borderline resectable pancreatic cancer (NCCN/IAP criteria) is defined by specific vascular contacts that make upfront R0 resection uncertain but potentially achievable with neoadjuvant therapy: solid tumour contact with the SMA ≤180°, contact with the common hepatic artery without encasement of the coeliac axis or aorta, and short-segment involvement of the SMV/portal vein (with reconstruction feasibility). Arterial encasement >270° or coeliac encasement indicates locally advanced (unresectable) disease. Distant nodal disease is M1 disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.