Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement

Table 1

National comprehensive cancer network practice guidelines in oncology for pancreatic adenocarcinoma-v.1.2008: criteria defining resectability status [2].

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Resectable

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Head/body/tail tumour

(i) No distant metastases

(ii) Clear fat plane around coeliac and SMA

(iii) Patent SMV/PV

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Borderline resectable

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Head/body

(i) Severe unilateral SMV/PV impingement

(ii) Tumour abutment on SMA

(iii) GDA encasement up to origin at HA

(iv) Tumours with limited involvement of the IVC

(v) SMV occlusion, if of a short segment, with open vein both proximally and distally (unresectable if occlusion of the proximal SMV up to the PV branches)

(vi) Colon or mesocolon invasion

Tail

(i) Adrenal, colon or mesocolon, kidney invasion

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Unresectable

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Head

(i) Distant metastases

(ii) SMA, coeliac artery encasement

(iii) SMV/PV occlusion

(iv) Aortic, IVC invasion or encasement

(vi) Invasion of SMV below transverse colon

Body

(i) Distant metastases

(ii) SMA, coeliac, HA encasement

(iii) SMV/PV occlusion

(iv) Aortic invasion

Tail

(i) Distant metastases

(ii) SMA, coeliac encasement

(iii) Rib, vertebral invasion

Nodal status

(i) Metastases to lymph nodes beyond the field of resection.

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GDA = Gastroduodenal artery
IVC = Inferior vena cava
PV = Portal vein
SMV = Superior mesenteric vein
SMA = Superior mesenteric artery.