Annals of Hepato-Biliary-Pancreatic Surgery

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Table. 1.

Table. 1.

Metastatic evidence of peritoneal and distant metastases

Stage Anatomy MCW NCCN (2019) MDACC AHPBA/SSO/SSAT
Resectable Artery (CA, SMA, or HA)
Vein (SMV, PV, or SMV-PV confluence)
No involvement
- No involvement
- If involved, ≤50% circumference narrowing of vein
No involvement
- No involvement ≤180° contact without vein contour irregularity
No involvement
- No involvement
- Abutment (provided vein is patent)
No involvement
No involvement
Borderline resectable Artery
CA
SMA
HA
Vein (SMV, PV, or SMV-PV confluence)
Abutment
Abutment
Short segment abutment/encasement without involving CA or HA bifurcation
>50% narrowinga
Head/uncinate:
• Contact with CHA without extension to CA or hepatic artery bifurcation
• Contact with the SMA of ≤180°
• Contact with variant arterial anatomy
Pancreatic body/tail:
• Contact with the CA of ≤180°
• Contact with the CA of >180° without involvement of the aorta and with intact and GDA
- Contact >180°a
- Contact ≤180° with contour irregularity or thrombosis of veina
- Contact with IVC
Abutment
Abutment
Abutment or short segment encasement
- Abutment with impingement and narrowinga
- Segmental venous occlusiona
Uninvolved
Abutment
Abutment or short segment encasement
Abutment, encasement, or short segment occlusiona
Locally advanced Artery
CA
SMA
HA
Vein (SMV, PV, or SMV-PV confluence)
Type A
Encasement but no extension to aortab
Encasement (>180° but ≤270°)
Encasement and extension to CAb
Type B
Encasement and extensión to aorta
>270° encasement
Encasement with extension beyond bifurcation of porper HA
Head/uncinate process:
• Contact with SMA >180°
• Contact with the CA >180° Pancreatic
Body/tail:
• Contact of >180° with the SMA or CA
• Contact with the CA and aortic involvement
Occlusion without options for reconstruction
<Encasement of CA, SMA and HA without options for reconstruction

Abutment is defined as ≤180° contact with vessel and encasement indicates >180° involvement

aAmenable for safe and complete resection and venous reconstruction

bAmenable for celiac resection (with or without reconstruction)

MCW, Medical College of Wisconsin; NCCN, National Comprehensive Cancer Network; MDACC, MD Anderson Cancer Center; CA, celiac axis; SMA, superior mesenteric artery; HA, hepatic artery; GDA, gastroduodenal artery; SMV, superior mesenteric vein; PV, portal vein; AHPBA, American Hepato-Pancreato-Biliary Association; SSAT, Society for Surgery of the Alimentary Tract; SSO, Society for Surgical Oncology19-23

Ann Hepatobiliary Pancreat Surg 2021;25:179-91 https://doi.org/10.14701/ahbps.2021.25.2.179
© 2021 Ann Hepatobiliary Pancreat Surg