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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.
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).
Showing the technology this term belongs to: CT (computed tomography).
Shares Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection), Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Borderline resectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting), CA 19-9, CT (computed tomography), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares CA 19-9, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares CA 19-9, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares CT (computed tomography), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Locally advanced unresectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.