# Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)

Source: https://onco.cc/terms/nccn-resectability-criteria-pancreatic/  
OnCo record `nccn-resectability-criteria-pancreatic` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Surgeons class a pancreatic cancer as resectable, borderline resectable or locally advanced by how far it wraps around the arteries and veins behind the pancreas on the CT scan, measured in degrees of contact. Less than half way round an artery, or a vein the surgeon can rebuild, is borderline; more is locally advanced. A very high CA 19-9 or poor fitness can also make a tumour borderline.

## Summary

The National Comprehensive Cancer Network adopted a definition of borderline resectable pancreatic cancer in 2006 and revised it yearly; the 2017 international consensus from the International Association of Pancreatology fixed three dimensions (Isaji 2018). Anatomical: tumour contact with the superior mesenteric artery or coeliac artery of less than 180 degrees without stenosis or deformity, contact with the common hepatic artery without involvement of the proper hepatic artery or coeliac artery, and contact with the superior mesenteric or portal vein including narrowing or occlusion that does not extend beyond the inferior border of the duodenum (so that reconstruction is possible). Biological: anatomically resectable disease with findings suspicious for, but unproven, distant or regional nodal metastases on PET-CT or biopsy, or a CA 19-9 above 500 U/mL. Conditional: anatomically and biologically resectable disease in a patient with performance status 2 or worse. Resectable disease has no arterial contact and venous contact of 180 degrees or less without contour irregularity; locally advanced (unresectable) disease has arterial encasement of more than 180 degrees or unreconstructable venous occlusion (NCCN; Tempero 2021). The classes are read off a pancreas protocol CT reported on the Society of Abdominal Radiology and American Pancreatic Association template, which asks the radiologist to state each vessel's degrees of contact (Al-Hawary 2014). In the UK the pancreatic multidisciplinary team applies them (NICE NG85 1.2.1). What follows from the class is on the parent page's treatment rows: surgery first for resectable disease (or neoadjuvant treatment in trials, NG85 1.8.2), chemotherapy first for borderline disease, and chemotherapy with or without radiotherapy or tumour treating fields for locally advanced disease, with re-imaging for conversion. A meta-analysis of seven randomised trials found neoadjuvant therapy improved survival in borderline resectable disease (hazard ratio 0.61) but not significantly in resectable disease (0.77) (van Dam 2022).

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: Anatomical resectability criteria; 180 degrees rule; Vessel contact criteria; Isaji criteria; Anatomical, biological and conditional borderline resectability; NCCN resectability classification
- Tags: gi; pancreatic

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Pancreatic_cancer
- Isaji, Pancreatology 2018: international consensus on the definition and criteria of borderline resectable pancreatic cancer: https://doi.org/10.1016/j.pan.2017.11.011
- Tempero, JNCCN 2021: NCCN pancreatic adenocarcinoma guidelines, version 2.2021: https://doi.org/10.6004/jnccn.2021.0017
- NCCN Guidelines: Pancreatic Adenocarcinoma (resectability criteria): https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455
- Al-Hawary, Radiology 2014: pancreatic ductal adenocarcinoma radiology reporting template (SAR and APA consensus): https://doi.org/10.1148/radiol.13131184
- van Dam, Eur J Cancer 2022: neoadjuvant therapy or upfront surgery for resectable and borderline resectable pancreatic cancer, meta-analysis of 7 trials: https://doi.org/10.1016/j.ejca.2021.10.023
- NICE NG85: pancreatic cancer in adults (diagnosis 1.1, staging 1.3, nutrition 1.6, biliary obstruction 1.7, resectable disease 1.8): https://www.nice.org.uk/guidance/ng85/chapter/Recommendations

## Connected records

- cancers: [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- technologies: [CT (computed tomography)](https://onco.cc/technologies/ct/), [PET/CT](https://onco.cc/technologies/pet-ct/)
- terms: [CA 19-9](https://onco.cc/terms/ca19-9/), [Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer](https://onco.cc/terms/neoadjuvant-versus-upfront-surgery-pancreatic/), [Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting)](https://onco.cc/terms/pancreas-protocol-ct/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)](https://onco.cc/terms/vascular-resection-pancreatic/)

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