CT criteria of the resectability of pankreas carcinoma

Pancreatic cancer is a relatively common tumor with an incidence of 7.6 per 100,000 in Western Europe, accounting for about 5% of all cancers. Unfortunately, the most pancreatic cancers are unresectable (about 80%) at the time of diagnosis, due to local tumor extension (40%) or presence of distant metastasis (40%). Pancreatic adenocarcinoma generally has a poor prognosis and preoperative assessment of cancer resectability is of vital importance for treatment planning. The last revision of international guidelines for preoperative computer tomography (CT) assessment of pancreatic cancer resectability was done in Japan 2016, for preoperative evaluation of tumor extensibility and resectability. It is based on the tumor extension on vascular and adjacent structures and presence of distant metastases using contrast enhanced computed tomography (CECT). It categorizes the tumor into three classes according to the presence or absence of vascular invasion: resectable, borderline resectable (BR), and unresectable (UR). Borderline resectable pancreatic cancer with invasion of vascular structures may be treated with neoadjuvant therapy for the purpose of understaging/undersizing and converting tumor into resectable stage, followed by more aggressive surgical resection. If explorative laparoscopy shows unresectable cancer some palliative procedures should be performed or percutaneous billiary drainage with stenting.