A 55-year-old male presents with painless jaundice, weight loss, and a palpable gallbladder. CT shows a mass at the pancreatic head with dilation of the main pancreatic duct and common bile duct (double-duct sign). CA 19-9 is markedly elevated. According to current criteria, which of the following would make this tumor UNRESECTABLE?
- A Superior mesenteric artery encasement >180 degrees ✓
- B Superior mesenteric artery abutment <180 degrees
- C Superior mesenteric vein (SMV) occlusion with reconstructable portal vein above and below
- D Portal vein involvement requiring segmental resection and reconstruction
Correct answer: A. Superior mesenteric artery encasement >180 degrees
Explanation
Based on the NCCN and AHPBA criteria, pancreatic head cancer with superior mesenteric artery (SMA) encasement exceeding 180 degrees of the vessel circumference is classified as locally unresectable. Venous involvement (portal vein, SMV) can often be managed with segmental resection and reconstruction and does not necessarily preclude resectability. Borderline resectable disease includes SMA abutment up to 180 degrees or reconstructable venous occlusion.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.