A 65-year-old patient with jaundice undergoes ERCP showing a distal CBD stricture. CA 19-9 is 520 U/mL and CT shows a hypoechoic pancreatic head mass with superior mesenteric vein (SMV) contact >180°. According to NCCN/ISGPS borderline resectable criteria, the next best step is:
- A Upfront Whipple's pancreaticoduodenectomy
- B Neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel followed by re-staging CT at 2-3 months ✓
- C Systemic chemotherapy alone (palliative intent)
- D Biliary bypass surgery (hepaticojejunostomy) and reassessment
Explanation
ISGPS/NCCN borderline resectable pancreatic cancer is defined by venous involvement (SMV/portal vein contact or short segment encasement ≤180°) without unreconstructable deformity. The preferred management is neoadjuvant chemotherapy (FOLFIRINOX preferred; gemcitabine/nab-paclitaxel as alternative) followed by re-staging to determine resectability before surgery. This approach selects patients with biology favorable enough to benefit from resection and improves R0 resection rates. Upfront surgery risks positive margins and higher perioperative morbidity without survival benefit.
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.