Borderline Resectable Pancreatic Cancer
It is essential to use rigorous criteria to define resectability which allows accurate pretreatment staging and the development of stage-specific therapy. Tumors of borderline resectability have emerged as a distinct subset with multidetector high quality
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Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1110
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Preoperative Staging and the Role of the Multidetector CT Scan . . . . . . . . . . . . . . . 1110
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Pancreaticoduodenectomy and the Retroperitoneal Margin . . . . . . . . . . . . . . . . . . . . . 1112
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Borderline (Marginally) Resectable Pancreatic Cancer – Definitions and CT Based Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1114
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Anatomic CT Based Criteria for Borderline Resectable Pancreatic Cancer – (Defined as MDACC, Type A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1114 5.1 Vascular Abutment on the Superior Mesenteric Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1114 5.2 Short Segment Abutment or Encasement of the Common Hepatic Artery . . . . . . . 1116 5.3 Segmental Venous Occlusion with Option for Reconstruction . . . . . . . . . . . . . . . . . . . . . 1116 6
Expanded Criteria for Borderline Resectable Pancreatic Cancer – Definition of MDACC Types B and C . . . . . . . . . . . . . . . . . . . . . 1116
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Role of Preoperative Therapy in Patients with Borderline Resectable (Types A, B, C) Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1117
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Barriers to Preoperative Therapy for Borderline Resectable Cancer . . . . . . . . . . . . 1120
J. P. Neoptolemos, R. Urrutia, J. L. Abbruzzese, M. W. Bu¨chler (eds.), Pancreatic Cancer, DOI 10.1007/978-0-387-77498-5_46, # Springer Science+Business Media, LLC 2010
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Borderline Resectable Pancreatic Cancer
Abstract: It is essential to use rigorous criteria to define resectability which allows accurate pretreatment staging and the development of stage-specific therapy. Tumors of borderline resectability have emerged as a distinct subset with multidetector high quality CT imaging and these patients are at a high risk for margin positive resection. Borderline resectable tumors are defined as those with tumor abutment of 180 (50%) of the SMA or celiac axis, short segment abutment or encasement of the common hepatic artery typically at the gastroduodenal artery origin, and segmental venous occlusion with sufficient venous flow above and below the occlusion to allow an option for venous reconstruction. Patients whose tumors meet these CT criteria are candidates for preoperative systemic chemotherapy followed by chemoradiation. Patients whose imaging studies show radiographic stability or regression and an improvement in serum tumor markers (CA19–9) may proceed to pancreaticoduodenectomy and may require vascular resection and reconstruction. Prospective clinical trials with well-defined eligibility criteria are necessary to determine the best overall treatment strategy for these patients.
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Background
Pancreatic cancer is a systemic disease in most patients; two thirds of patients have locally advanced or metastatic di
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