A 68-year-old man undergoes staging CT for pancreatic head adenocarcinoma. The report notes tumour contact with the superior mesenteric artery (SMA) spanning 200°, contact with the superior mesenteric vein (SMV) with deformity but preserved contour, and no distant metastases. Per NCCN 2024 guidelines, this is classified as:
- A Locally advanced (unresectable) ✓
- B Resectable
- C Borderline resectable
- D Metastatic
Correct answer: A. Locally advanced (unresectable)
Explanation
Per NCCN 2024, locally advanced (unresectable) pancreatic cancer is defined by SMA contact >180° (this case: 200°), celiac axis contact >180°, or aortic involvement. Borderline resectable requires SMA contact ≤180°, or SMV/portal vein involvement amenable to reconstruction. The 200° SMA contact in this case exceeds the borderline threshold, classifying it as locally advanced unresectable, making upfront surgery inappropriate; neoadjuvant FOLFIRINOX-based therapy is considered.
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.