Current controversies and advances in the management of pancreatic adenocarcinoma

Table 5 Criteria defining resectability status of pancreatic adenocarcinoma[30]

Resectability status	Arterial	Venous
Resectable	No arterial tumor contact (CA, SMA, or CHA)	No tumor contact with the SMV or PV or ≤ 180° contact without vein contour irregularity
Borderline resectable	Pancreatic head/uncinate process: Solid tumor contact with CHA without extension to CA or hepatic artery bifurcation. Solid tumor contact with the SMA of ≤ 180°; Solid tumor contact with variant arterial anatomy (ex: Accessory right hepatic artery, replaced right hepatic artery, replaced CHA, and the origin of replaced or accessory artery). Pancreatic body/tail: Solid tumor contact with the CA of ≤ 180°; Solid tumor contact with the CA of > 180° without involvement of the aorta and with intact and uninvolved gastroduodenal artery thereby permitting a modified Appleby procedure (controversial)	Solid tumor contact with the SMV or PV of > 180°, contact of ≤ 180° with contour irregularity of the vein or thrombosis of the vein but with suitable vessel proximal and distal to the site of involvement allowing for safe and complete resection and vein reconstruction. Solid tumor contact with the IVC
Locally advanced	Head/uncinate process: Solid tumor contact with SMA > 180°; Solid tumor contact with the CA > 180°. Pancreatic body/tail: Solid tumor contact of > 180° with the SMA or CA; Solid tumor contact with the CA and aortic involvement	Unreconstructible SMV/PV due to tumor involvement or occlusion (can be due to tumor or bland thrombus)

CA: Celiac axis; SMA: Superior mesenteric artery; CHA: Common hepatic artery; SMV: Superior mesenteric vein; PV: Portal vein; IVC: Inferior vena cava.