Table 3.
Resectability criteria [57]
Category | Arterial | Venous |
---|---|---|
Resectable | Absence of tumoral contact with CT, MSA or CHA | Absence of tumoral contact with SMV or PV or contact ≤180° without irregularities in the venous contour |
Borderline resectable | Head of the pancreas and uncinate process Solid tumoral contact with CHA, without extension to CT or HA bifurcation, that allows resection and complete and safe vascular reconstruction Solid tumoral contact with SMA ≤180° The presence of arterial anatomic variants should be evaluated (i.e., right accessory HA, replacement of right HA, replacement of CHA as well as source of replaced or accessory artery) and the presence and degree of tumoral contact due to their influence when planning the surgical procedure Body and tail of the pancreas Solid tumoral contact with CT ≤ 180° Solid tumoral contact with CT > 180° without aorta involvement and with intact GDA (there is no consensus on this criteria and can be included in the non-resectable category) |
Solid tumoral contact with SMV or PV >180°, contact ≤180° with irregularities in the venous contour or venous thrombosis but with adequate proximal and distal ends that allow safe vascular resection and replacement Solid tumor contact with IVC |
Non-resectable | Distant metastasis (including metastasis in non-regional lymph nodes) Head of the pancreas and uncinate process Solid tumoral contact with SMA or CT >180° Solid tumoral contact with the first jejunal branch of SMA Body and tail of the pancreas Solid tumoral contact with SMA or CTC > 180° Solid tumoral contact with CT and aortic infiltration |
Head of the pancreas and uncinate process Tumoral infiltration or thrombosis (thrombosis may not be tumoral) in SMV or PV, that does not allow reconstruction Contact with the most proximal jejunal vein that drains in SMV Body and tail of the pancreas Tumoral infiltration or thrombosis (the thrombosis may not be tumoral) in SMV or PV, that does not allow reconstruction |
CT celiac trunk, SMA superior mesenteric artery, CHA common hepatic artery, SMV superior mesenteric vein, PV portal vein, IVC inferior vena cava inferior, GDA gastroduodenal artery