Pancreatic ductal adenocarcinoma (PDAC) is classified as 'borderline resectable' (BR-A) by NCCN criteria. Which of the following features qualifies a tumor as BR-A?

• A Abutment of the SMA with >180° interface and tumor extension to the celiac axis
• B Solid tumor contact with the SMA of ≤180° or abutment of the celiac axis with <180° in the head/uncinate without involving the aorta ✓
• C Solid tumor contact with the superior mesenteric vein/portal vein (SMV/PV) of >180° with contour irregularity or thrombosis
• D Any tumor with CA 19-9 >1000 U/mL regardless of vascular contact

Explanation

NCCN borderline resectable PDAC (head/uncinate) criteria for arterial involvement (BR-A type) include: solid tumor contact with the superior mesenteric artery (SMA) ≤180°, or contact with the variant right hepatic artery, or contact with the common hepatic artery (without extension to celiac axis or proper hepatic). Venous involvement (BR-V type) includes SMV/portal vein contact >180° or ≤180° with contour irregularity or thrombosis amenable to reconstruction. SMA involvement >180° or celiac axis involvement with aortic extension constitutes locally advanced/unresectable disease. BR tumors receive neoadjuvant chemotherapy (often FOLFIRINOX) followed by restaging and surgery if no progression.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.