Q What is the meaning of Borderline Resectability in Pancreatic tumors?
A In Carcinoma head of pancreas Varadhachary and colleagues introduced the term borderline resectable to include those tumors with limited arterial abutment (defined as tumor-vessel contact of <180°) or venous abutment or encasement (defined as tumor-vessel contact of >180°). The introduction of the terms abutment and encasement allowed physicians to use accurate terminology in contrast to the vague descriptors used in the past such as venous “involvement,” which may have been used to describe subtle tumor abutment and near-complete vessel occlusion.
Also added are tumors with arterial abutment in which resection maybe possible after neoadjuvant therapy
Short segment venous involvement
Further Refinement to the definition was done by Katz
Katz Type Patient, Tumor, or Disease Characteristics
A CT images to include 1 or more of the following findings:
(1) tumor abutment (180° or less of the circumference of the vessel) of the SMA or celiac axis
(2) tumor abutment or encasement (>180° of the circumference of the vessel) of a short segment of the hepatic artery, typically at the origin of the gastroduodenal artery
(3) short-segment occlusion of the SMV, PV, or SMV-PV confluence that was amenable to vascular resection and reconstruction because of a patent SMV and PV below and above the area of tumor-related occlusion
B Patients with borderline resectable disease because of a concern for possible extrapancreatic metastatic disease. This subgroup included those with CT findings suspicious for, but not diagnostic of, metastatic disease and those with known N1 disease from either prereferral laparotomy or EUS-guided FNA
C Patients with borderline resectable disease because of a marginal performance status (Zubrod 3), or those with a better performance status and significant preexisting medical comorbidity believed to require protracted evaluation that precluded immediate surgery.
