Definitions of Resectability of Pancreatic Adenocarcinoma (PDAC)

  • 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

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