Definitions of Resectability of Pancreatic Adenocarcinoma (PDAC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Several definitions of resectability of pancreatic adenocarcinoma (PDAC) have been approved for determining the possibility for complete clearance (R0 resection) by surgery:
    • Taking into account oncological and general aspects
  • Surgical resectability of PDAC is assessed by:
    • The evaluation of local tumor extension to vessels and distant metastases
  • Excluding tumor with distant metastases:
    • Which is defined as unresectable with metastases (UR‐M:
  • Local resectability is classified in three categories:
    • Resectable (R)
    • Borderline resectable (BR)
    • Unresectable (UR‐LA)
  • R PDAC shows:
    • No vascular infiltration to major vessels
    • Complete clearance of R tumor is required in standard pancreatectomy without combined vascular resection
  • BR PDAC is sub‐classified into two categories:
    • BR‐PV showing PV distortion or narrowing
    • BR‐A showing semi‐circumferential abutment with a major artery
      • There is a theoretical “borderline” between BR‐PV and BR‐A:
        • Whereas PV resection is currently recommended for achieving R0 resection:
          • Arterial resection remains controversial due to significantly increased rates of morbidity
    • From the surgical perspective, BR‐PV PDAC is borderline resectable:
      • Whereas BR‐A PDAC is borderline unresectable
    • Considering surgical feasibility:
      • R and BR‐PV PDAC should be considered as:
        • Candidates for “PDAC that is planned for resection (potentially resectable PDAC):
          • Potentially resectable PDAC has been treated by upfront surgery, although neoadjuvant for BR PDAC might be considered given the poor oncological outcomes

#Arrangoiz #CancerSurgeon #SurgicalOncology #CASO #CenterforAdvancedSurgicalOncology

Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment