In assessing resectability of pancreatic ductal adenocarcinoma of the head, which of the following findings on CT would define 'borderline resectable' status according to the AHPBA/SSAT/SSO consensus criteria?
- A Tumour abutment of the superior mesenteric artery (SMA) involving 90° or less of the vessel circumference
- B Encasement of the coeliac axis >180°
- C Short segment occlusion of the superior mesenteric vein (SMV) amenable to reconstruction ✓
- D Metastatic deposit in segment 6 of the liver
Correct answer: C. Short segment occlusion of the superior mesenteric vein (SMV) amenable to reconstruction
Explanation
Borderline resectable pancreatic cancer includes tumours with: (1) abutment of the SMA ≤180°, (2) abutment or short-segment occlusion of the SMV/portal vein that is reconstructable, or (3) abutment of the hepatic artery ≤180°. Short-segment venous occlusion amenable to reconstruction exemplifies borderline resectable disease. Coeliac axis encasement >180° is generally unresectable. Hepatic metastasis defines metastatic (Stage IV) disease. SMA abutment >180° is unresectable.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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