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Pancreatic Resectability — SCE Medical Oncology MCQ

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ModerateGI CancersPancreatic ResectabilitySCE Medical Oncology

A 60-year-old man with a pancreatic body mass undergoes EUS-guided biopsy confirming adenocarcinoma. CT shows the tumour encasing >180° of the superior mesenteric artery (SMA). This is classified as locally advanced unresectable. Why is SMA encasement the key criterion?

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Correct answer: B — SMA encasement >180° represents borderline/unresectable disease because the SMA cannot be safely resected and reconstructed (unlike the SMV/portal vein which can be resected and reconstructed)

In pancreatic cancer, arterial involvement (SMA, coeliac axis, hepatic artery) is the key determinant of resectability. SMA encasement >180° is classified as unresectable because the SMA cannot be resected and reconstructed (unlike the SMV/portal vein where segmental resection and reconstruction is routinely performed). The NCCN/AHPBA definitions classify: resectable (no arterial contact), borderline resectable (≤180° arterial abutment), and unresectable (>180° arterial encasement or occlusion).

Reference: ESMO 2024 Pancreatic Cancer; NICE NG85; NCCN Resectability Criteria; AHPBA Consensus