Table 1. Pancreatic cancer staging (criteria defining tumour resectability status according to NCCN guidelines, version 2.2015).
Resectability status arterial involvement venous involvement |
Resectable |
No contact with coeliac axis (CA), superior mesenteric artery (SMA), or common hepatic artery (CHA) |
No contact with the superior mesenteric vein (SMV), or portal vein (PV) or _180_ contact without vein contour irregularity |
Borderline resectable |
Pancreatic head/uncinate process |
Solid tumour in contact with CHA without extension to CA or hepatic artery bifurcation allowing for safe and complete resection and reconstruction |
Solid tumour contact with the SMA of _180_ |
Presence of variant arterial anatomy (ex: accessory right hepatic artery.) and the presence and degree of tumour contact should be noted if present as it may affect surgical planning |
Pancreatic body/tail |
Solid tumour contact _180_ with the CA |
Solid tumour contact >180_ with the CA without involvement of the aorta and with intact and uninvolved gastroduodenal artery (some members prefer this criteria to be in the unresectable category) |
Solid tumour in contact >180_ with the SMV or PV, or in contact _180_ with contour irregularity of the vein or thrombosis of the vein but with suitable vessels proximal and distal to the site of involvement allowing for safe and complete resection and vein reconstruction |
Solid tumour contact with the inferior vena cava (IVC) |
Unresectable _distant metastasis |
Head/uncinate process |
Solid tumour contact with SMA >180_ |
Solid tumour contact with the CA >180_ |
Solid tumour contact with the first jejunal SMA branch |
Body and tail |
Solid tumour contact >180_ with the SMA or CA |
Solid tumour contact with the CA and aortic involvement |
Head/uncinate process |
Unreconstructible SMV/PV due to tumor involvement or occlusion (can be due to tumor or bland thrombus) |
Contact with most of the proximal draining jejunal branch into the SMV |
Body and tail |
Unreconstructible SMV/PV due to tumour involvement or occlusion (can be due to tumour burden) |
Abbreviations: CA, coeliac axis; SMA, superior mesenteric artery; CHA, common hepatic artery; SMV, superior mesenteric vein; PV, portal vein; IVC, inferior vena cava.