Resectability classification in pancreatic cancer in the 7th Edition of General Rules for the Study of Pancreatic Cancer by the Japan Pancreas Society

Abstract

In the 7th edition of General Rules for the Study of Pancreatic Cancer by the Japan Pancreas Society (JPS), criteria defining resectability status based on dynamic CT findings have been established after thorough discussion among pancreatic surgeons, gastroenterologist, radiologist, and pathologist, taking into consideration the National Comprehensive Cancer Network (NCCN) 2015 guidelines. The purpose of defining resectability criteria is to improve patient selection for surgery and to identify the likelihood of an R0 resection. These criteria are considered to be utilizable by pancreatic surgeons, as well as gastroenterologist and radiologist alike. Since the criteria are objective, based solely on dynamic CT findings, they avoid subjective definitions such as "SMV/PV involvement allowing for safe and complete resection and vein reconstruction" in BR pancreatic cancer and "unreconstructable SMV/PV due to tumor involvement or occlusion" in UR pancreatic cancer. Instead of subjective definitions for SMV/PV involvement, we have adopted the objective definition: SMV/PV involvement exceeding or not exceeding the inferior border of the duodenum. Proper R0 resection and treatment option of adjuvant and neo-adjuvant therapy should be compared and discussed on common criteria.