Patient selection: limited pancreatic carcinoma without evidence of metastasis
Parameters:
(1) involvement of the superior mesenteric artery
(2) celiac and/or hepatic artery
(3) superior mesenteric vein and/or portal vein
A pancreatic tumor is considered resectable if all of the following are present:
(1) there is no extension to the superior mesenteric artery
(2) there is no extenstion to involve the celiac and hepatic arteries
(3) the superior mesenteric vein and portal vein are patent
A pancreatic tumor is unresectable if any of the following are present
(1) the superior mesenteric artery is encased (> 180° of circumference) by tumor
(2) the celiac and/or hepatic arteries are encased AND there is no technical option for reconstruction to the arteries arising from these
(3) the superior mesenteric and/or portal veins are occluded AND there is no technical option for reconstruction
A pancreatic cancer is potentially resectable (borderline) if:
(1) the superior mesenteric artery has circumferential involvement of <= 180°
(2) there is short segment encasement or abutment of the celiac and/or hepatic arteries with the ability to reconstruct the arterial supply once the tumor is resected
(3) there is short segment occlusion of the superior mesenteric and/or portal veins with a suitable vessel above or below that will allow for surgical reconstruction
where:
• Short segment occlusion of the superior mesenteric vein without involvement of the superior mesenteric artery is rare. The extent of involvement should be evident on a CT scan.
• The presence of tumor about the superior mesenteric artery that shows periarterial stranding and a convexity around the vessel is associated with a greater chance for resection.
