A 62-year-old patient has a 3 cm pancreatic head adenocarcinoma with portal vein involvement over a 1.5 cm segment without occlusion. CA 19-9 is 420 U/mL. CT shows no distant metastasis. How is this tumor classified per NCCN 2024 borderline resectability criteria?

• A Resectable — portal vein involvement alone does not affect resectability
• B Locally advanced — portal vein encasement > 180° is unresectable
• C Borderline resectable — portal/SMV involvement without occlusion is a defining criterion ✓
• D Metastatic — elevated CA 19-9 indicates systemic spread

Explanation

NCCN criteria for borderline resectable pancreatic cancer include: solid tumor contact with the portal vein or superior mesenteric vein (SMV-PV) without occlusion and with reconstructible vessel; contact with superior mesenteric artery (SMA) ≤ 180°; contact with celiac axis ≤ 180° (body tumors); hepatic artery contact reconstructible. In this case, 1.5 cm portal vein involvement without occlusion qualifies as borderline resectable. Neoadjuvant therapy (gemcitabine/nab-paclitaxel or FOLFIRINOX) is recommended before surgery. Locally advanced requires > 180° SMA/celiac encasement. CA 19-9 elevation alone does not indicate metastasis.

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

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