Contraindications for attempting surgical resection of a pancreatic adenocarcinoma:
(1) metastases to the liver (absolute)
(2) metastases to the peritoneum (absolute)
(3) metastases to an extra-abdominal site (absolute)
(4) encasement of one or more major arteries (celiac artery, hepatic artery, superior mesenteric artery)
(5) involvement of the spleno-portal confluence (relative)
(6) involvement of the bowel mesentery (relative)
(7) involvement of the superior mesenteric vein (relative)
(8) > 50% involvement of the portal vein circumference (relative)
The presence of one or more contraindication means that:
(1) A complete resection of the tumor may be futile.
(2) Attempting a resection may be hazardous to the patient (risk may be greater than benefit).
(3) An experienced surgeon may be able to attempt a resection if a relative contraindication and favorable features are present.
(4) Palliative surgery should be considered.
