Staging and Determination of Resectability of Pancreatic Cancer

Abstract

The prognosis of patients with pancreatic cancer is extremely poor because of the majority of patients presenting with advanced disease. Early diagnosis and staging thus are indispensable for the improvement of outcomes in patients with pancreatic cancer. Preoperative staging of pancreatic cancer helps to determine the therapeutic strategy for pancreatic cancer. TNM staging system for pancreatic cancer placed emphasis on both resectability and prognostic classification, which includes tumor size and extent (T), lymph node status (N), and evidence of distant metastases (M). The combination of T, N, and M into stage groupings accurately reflects the differences in prognosis among patients with resectable, locally advanced, and distant metastatic disease. Tumors classified in stage I are small and localized within pancreas, therefore, are routinely resectable. Tumors classified in stage II are extent to adjacent organs or involving regional lymph nodes, without distant metastases or invasion to celiac trunk or superior mesenteric artery and are usually resectable. Although tumors classified in stage IV are unresectable due to distant metastases, the resectability of stage III is controversial. The stage III category includes a wide range of tumor-vessel involvement, and involvement of a limited area of the visceral arteries is so-called a borderline resectable situation. The resectability of tumor abutment or encasement of the superior mesenteric or portal vein also remains controversial, although venous resection is no longer a contraindication to pancreaticoduodenectomy at many centers. TNM staging system is important to classify patients with pancreatic adenocarcinoma into prognostic subgroups and perform appropriate therapies for each stage patients. However, the resectability of pancreatic adenocarcinoma is changing as the improvement in surgical techniques and chemotherapeutic options. Further clinical trials are required to establish evidence-based multimodality approach for borderline resectable pancreatic adenocarcinoma.