Table 2 The defining criteria of tumor resectability according to the National Comprehensive Network (NCCN) guidelines (2019) and the International Association of Pancreatology (IAP) consensus (2016)
From: Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review
Resectibility | NCCN (2019) | IPA consensus (2016) |
|---|---|---|
Resectable | • No tumor-vessel contact | • Same |
• ≤ 180° tumor contact with SMV/PV WITHOUT venous contour irregularity | • Unilateral narrowing of the vein | |
Borderline resectable (veins) | • > 180° tumor contact with SMV/PV • ≤ 180° tumor contact with SMV/PV + venous contour irregularity or thrombosis if the vein is reconstructible • Tumor contact with IVC | • > 180° tumor contact with SMV/PV or bilateral narrowing or occlusion without extension beyond the inferior border of the duodenum |
Borderline resectable (arteries) | • ≤ 180° tumor contact with CA/SMA | • ≤ 180° tumor contact with CA/SMA but without artery deformity or stenosis |
• Tumor contact with CHA WITHOUT extension to CA or HA bifurcation | • Same | |
• Tumor contact with a variant arterial anatomy | • Not included | |
Unresectable | • Metastasis “including non-regional LN” • > 180° tumor contact with CA or SMA • Tumor contact with Aorta | • Same |
• Unreconstructible SMV/PV due to tumor invasion or bland/tumor thrombosis | • Occlusion or bilateral narrowing of SMV/PV extending beyond the inferior border of the duodenum | |
• Tumor contact with the most proximal draining jejunal branch into SMV or the first jejunal SMA branch | • Not included |