A 65-year-old woman is found on CT to have a 4 cm pancreatic head mass with duct-of-Wirsung dilatation. EUS-FNA confirms pancreatic ductal adenocarcinoma. CT criteria show tumor abutting the superior mesenteric artery (SMA) over 150° circumferentially and 2 cm involvement of the hepatic artery. Per NCCN criteria, this tumor is classified as:

• A Resectable
• B Locally advanced unresectable ✓
• C Borderline resectable
• D Metastatic

Explanation

Per NCCN 2023 criteria for pancreatic adenocarcinoma, locally advanced (unresectable) disease requires: solid tumor contact with SMA >180° or unreconstructable SMV/PV, aortic invasion, unreconstructable common hepatic artery involvement, or celiac axis involvement >180°. SMA abutment of >150° is borderline (if ≤180°), but 2 cm hepatic artery involvement with circumferential encasement classifies this as unresectable. Borderline resectable involves SMA contact ≤180°, reconstructable hepatic artery, or short SMV/PV contact. Resectable means no arterial abutment and ≤180° SMV/PV contact. No distant metastases are described.

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

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Written and medically reviewed by the StethoPrep medical team.