Zeeshan MS, Ramzan Z. Current controversies and advances in the management of pancreatic adenocarcinoma. World J Gastrointest Oncol 2021; 13(6): 472-494 [PMID: 34163568 DOI: 10.4251/wjgo.v13.i6.472]
Corresponding Author of This Article
Zeeshan Ramzan, AGAF, FACG, Associate Professor, Gastrointestinal Section, Department of Medicine, Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX 76104, United States. zeeshanramzan@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jun 15, 2021; 13(6): 472-494 Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.472
Table 1 Tumor-node-metastasis staging of pancreatic adenocarcinoma [American Joint Committee on Cancer Tumor-Node-Metastasis Staging of Pancreatic Cancer (8th edition, 2017)]-T staging
T
Primary tumor
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ. This includes high-grade pancreatic intraepithelial neoplasia (PanIn-3), intraductal papillary mucinous neoplasm with high-grade dysplasia, intraductal tubulopapillary neoplasm with high-grade dysplasia, and mucinous cystic neoplasm with high-grade dysplasia
T1
Tumor ≤ 2 cm in greatest dimension
T1a
Tumor ≤ 0.5 cm in greatest dimension
T1b
Tumor > 0.5 cm and < 1 cm in greatest dimension
T1c
Tumor 1–2 cm in greatest dimension
T2
Tumor > 2 cm and ≤ 4 cm in greatest dimension
T3
Tumor > 4 cm in greatest dimension
T4
Tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic artery, regardless of size
Table 2 Tumor-node-metastasis staging of pancreatic adenocarcinoma [American Joint Committee on Cancer Tumor-Node-Metastasis Staging of Pancreatic Cancer (8th edition, 2017)]-N staging
N
Regional lymph nodes
NX
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastases
N1
Metastasis in one to three regional lymph nodes
N2
Metastasis in four or more regional lymph nodes
Table 3 Tumor-node-metastasis staging of pancreatic adenocarcinoma [American Joint Committee on Cancer Tumor-Node-Metastasis Staging of Pancreatic Cancer (8th edition, 2017)]-M staging
M
Distant metastasis
M0
No distant metastasis
M1
Distant metastasis
Table 4 Tumor-node-metastasis staging of pancreatic adenocarcinoma [American Joint Committee on Cancer Tumor-Node-Metastasis Staging of Pancreatic Cancer (8th edition, 2017)]-tumor-node-metastasis staging
Stages
T
N
M
Stage 0
Tis
N0
M0
Stage IA
T1
N0
M0
Stage IB
T2
N0
M0
Stage IIA
T3
N0
M0
Stage IIB
T1, T2, T3
N1
M0
Stage III
T1, T2, T3
N2
M0
T4
Any N
M0
Stage IV
Any T
Any N
M1
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)
Table 6 Treatment protocols for pancreatic adenocarcinoma in adjuvant setting
Citation: Zeeshan MS, Ramzan Z. Current controversies and advances in the management of pancreatic adenocarcinoma. World J Gastrointest Oncol 2021; 13(6): 472-494