A 62-year-old man with a 3 cm pancreatic head mass undergoes staging CT and is found to have superior mesenteric vein (SMV) involvement over a 2 cm segment with complete occlusion. The superior mesenteric artery (SMA) is uninvolved. Per National Comprehensive Cancer Network (NCCN) criteria, this tumor is classified as:
- A Resectable
- B Borderline resectable ✓
- C Locally advanced (unresectable)
- D Metastatic
Correct answer: B. Borderline resectable
Explanation
NCCN defines borderline resectable pancreatic cancer as having: SMV/portal vein involvement (abutment, encasement, or short-segment occlusion amenable to vascular reconstruction), or SMA/celiac abutment up to 180°. Complete SMV occlusion over 2 cm with suitable vessels above and below for reconstruction is borderline resectable, not locally advanced. Locally advanced (unresectable) requires SMA or celiac encasement >180° or aortic invasion.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.