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% narrowing |
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° - Contact ≤180° with contour irregularity or thrombosis of vein - Contact with IVC |
Abutment Abutment Abutment or short segment encasement - Abutment with impingement and narrowing - Segmental venous occlusion |
Uninvolved Abutment Abutment or short segment encasement Abutment, encasement, or short segment occlusion |
|
| Locally advanced | Artery CA SMA HA Vein (SMV, PV, or SMV-PV confluence) |
Type A Encasement but no extension to aorta Encasement (>180° but ≤270°) Encasement and extension to CA |
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