A 70-year-old woman presents with progressive painless jaundice and a CT scan showing a dilated CBD, bile ducts, and a pancreatic mass at the head of pancreas. CA 19-9 is 850 U/mL. CT shows the SMA and SMV appear clear of tumour involvement with no involvement of the portal vein. The superior mesenteric artery contact is <180°. According to NCCN resectability criteria, this tumour is classified as:
- A Resectable ✓
- B Borderline resectable
- C Locally advanced (unresectable)
- D Metastatic
Explanation
NCCN resectability criteria for pancreatic head cancer define: Resectable — no arterial contact (SMA, celiac, common hepatic artery) and no venous involvement (SMV/portal vein) or involvement allowing safe reconstruction. Borderline resectable — SMA contact >180°, celiac contact, SMV/portal vein involvement requiring reconstruction. Locally advanced — SMA or celiac encasement >180°, aortic invasion. Here, SMA contact <180° with clear SMV/PV means the tumour meets resectable criteria. The patient should proceed to upfront surgical resection (Whipple's pancreaticoduodenectomy) without neoadjuvant therapy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.