A 55-year-old patient with pancreatic head cancer is being evaluated for resectability. CT shows the tumor abuts the superior mesenteric artery (SMA) over 170 degrees of circumference with no fat plane. According to NCCN/AHPBA 2017 consensus, this is classified as:
- A Resectable — proceed with Whipple's
- B Borderline resectable — neoadjuvant therapy recommended
- C Locally advanced/unresectable — systemic therapy ✓
- D Metastatic — palliative chemotherapy only
Explanation
NCCN and AHPBA/SSO/SSAT consensus criteria for pancreatic cancer resectability: Resectable — no arterial contact, <180 degrees SMV/portal vein contact. Borderline resectable — SMV/portal vein involvement with reconstruction feasible, or SMA/celiac contact ≤180 degrees. Locally advanced (unresectable) — SMA contact >180 degrees, celiac axis involvement, or unreconstructable SMV/portal vein. Involvement of the SMA by >180 degrees (170 degrees in this case exceeds borderline threshold of ≤180 degrees technically, but 170 degrees is borderline by some criteria — however, combined with no fat plane indicating true encasement, most guidelines would classify >180 degrees as locally advanced). This patient with 170 degrees abutment and absent fat plane would be borderline to locally advanced by most criteria.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.