# PDAC resectability — Pancreatic ductal adenocarcinoma anatomic resectability classification

> Records a complete, versioned tumor-vessel and metastatic observation vector before assigning resectable, borderline resectable, locally advanced, or metastatic PDAC. Anatomic category is distinct from TNM stage, biologic risk, performance status and operability; it neither guarantees nor permanently excludes resection and cannot choose upfront surgery, neoadjuvant therapy, systemic therapy or palliation without multidisciplinary context.

**Situação:** vigente · **Órgão:** Pâncreas · **Órgão emissor:** NCCN / Society of Abdominal Radiology / multidisciplinary pancreatic oncology · **Versão:** NCCN-style anatomic criteria reviewed through v2.2025; structured-report and multidisciplinary boundaries through 2026 · **Ano:** 2026

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: algoritmo
- Tipo de lógica: flat
- Modalidade: CT, MRI
- Fonte primária: Lee SS, Kim DW, Lee W, Kim KP. Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability (2026) — https://pmc.ncbi.nlm.nih.gov/articles/PMC13333231/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Report observations first and the versioned label second. Anatomic resectability, TNM, biology, fitness, actual operability and treatment are separate decisions.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| resectable | Resectable | Under the detailed NCCN-style map reproduced in the 2023 staging review: no solid tumor contact with the celiac axis, superior mesenteric artery or common hepatic artery; and either no SMV/PV contact or contact of 180 degrees or less without venous contour irregularity. The current v2.2025 summary describes no major-artery contact and no major-vein contact or venous abutment without deformity. State the named version and preserve vessel measurements. | Refer to pancreatic multidisciplinary review with pathology, complete staging, biologic risk and patient fitness. Upfront resection with systemic-therapy planning and neoadjuvant approaches can both be valid for selected anatomically resectable PDAC; the label is not an automatic surgery order and does not prove physiologic operability. | This category describes favorable local anatomy under a named convention, not low-risk cancer, cure or guaranteed R0 resection. Recurrence remains common even after margin-negative surgery, and biology, occult disease and condition can outweigh the anatomic label. | Lee et al. 2026, DOI 10.3348/kjr.2026.0341, PMC13333231, Table 1 and treatment-strategy section; Chu and Fishman 2023, DOI 10.1097/JS9.0000000000000899, PMC11486980, Table 1 detailed degree-based thresholds; Moir et al. 2023, PMC11203077, MDT boundary. | ✓ |
| borderline-resectable | Borderline resectable | Under the detailed NCCN-style map: for head/uncinate tumors, common hepatic artery contact without extension to the celiac axis or hepatic bifurcation, SMA contact of 180 degrees or less, or relevant variant-artery contact; for body/tail tumors, celiac-axis contact of 180 degrees or less. Venous criteria include SMV/PV contact over 180 degrees, or 180 degrees or less with contour irregularity or thrombosis, only when suitable proximal and distal vessel permits reconstruction. Current v2.2025 summaries also include reconstructible PV/SMV/IVC deforming abutment or encasement. Version and center convention are mandatory. | Neoadjuvant systemic therapy and later restaging are commonly considered, but regimen, radiation, exploration and vascular reconstruction require expert multidisciplinary assessment of pathology, biology, performance status, response and center capability. Borderline does not itself mandate one regimen or forbid resection. | The anatomy raises technical and margin-positive-resection risk relative to the named resectable group, but it remains a potentially curative-intent category in selected patients. No fixed R0, conversion or survival probability should be attached without a matching cohort and treatment era. | Chu and Fishman 2023, PMC11486980, Table 1 site-specific arterial, venous-degree and reconstructibility criteria; Lee et al. 2026, PMC13333231, Table 1 and borderline/NAT sections; Al-Hawary et al. 2014, DOI 10.1148/radiol.13131184, vessel reporting consensus. | ✓ |
| locally-advanced | Locally advanced (unresectable) | Nonmetastatic locally advanced anatomy under the detailed NCCN-style map includes SMA or celiac-axis contact greater than 180 degrees, body/tail celiac involvement extending to the aorta, or SMV/PV tumor involvement or occlusion that is not reconstructible. The current v2.2025 summary additionally describes extensive major-artery encasement and hepatic-artery involvement extending to the celiac axis or hepatic bifurcation. Reconstructibility is an MDT judgment based on the reported objective anatomy, not a silent CT assumption. | Systemic therapy is commonly the initial backbone; selected patients may later undergo local therapy or conversion-to-resection evaluation at experienced centers. The category does not prescribe a regimen, establish permanent nonoperability or justify omitting restaging after treatment response. | This is extensive local anatomy with lower historical probability of immediate margin-negative resection, not a personal survival estimate or statement of futility. Response, biology, metastasis-free interval, patient condition and technical expertise can change candidacy over time. | Lee et al. 2026, PMC13333231, Table 1 locally advanced criteria and post-NAT section; Chu and Fishman 2023, PMC11486980, Table 1 greater-than-180-degree and unreconstructible-vein thresholds; Moir et al. 2023, PMC11203077, center-dependent resectability and objective vessel reporting. | ✓ |
| metastatic | Metastatic | Definite distant metastatic disease (M1), with every site and evidentiary basis named. Regional nodes remain N stage, while nonregional nodes can be M1. A tiny or otherwise indeterminate liver, lung, peritoneal, nodal, bone or other lesion must remain indeterminate and must not be promoted automatically to metastatic disease. | Multidisciplinary oncology management is usually systemic and goal-directed, with germline/somatic evaluation and symptom-directed procedures when appropriate. The label does not choose a drug regimen, prove that every local intervention is inappropriate, or replace patient goals, performance status and supportive-care assessment. | M1 denotes systemic spread and generally dominates the four-label output, but it is not a fixed individual survival clock or synonym for immediate futility. Preserve metastatic burden, biology, symptoms, treatment response and uncertainty separately. | Lee et al. 2026, PMC13333231, comprehensive distant-staging and treatment context; ACR Appropriateness Criteria revised 2025, locoregional and distant assessment variants; Moir et al. 2023, PMC11203077, template Part A metastatic sites and indeterminate post-treatment findings. | ✓ |

### Citações por categoria
- **resectable**: Lee SS, Kim DW, Lee W, Kim KP. Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability (2026) — https://pmc.ncbi.nlm.nih.gov/articles/PMC13333231/ · Lee et al. 2026, DOI 10.3348/kjr.2026.0341, PMC13333231, Table 1 and treatment-strategy section; Chu and Fishman 2023, DOI 10.1097/JS9.0000000000000899, PMC11486980, Table 1 detailed degree-based thresholds; Moir et al. 2023, PMC11203077, MDT boundary.
- **borderline-resectable**: Lee SS, Kim DW, Lee W, Kim KP. Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability (2026) — https://pmc.ncbi.nlm.nih.gov/articles/PMC13333231/ · Chu and Fishman 2023, PMC11486980, Table 1 site-specific arterial, venous-degree and reconstructibility criteria; Lee et al. 2026, PMC13333231, Table 1 and borderline/NAT sections; Al-Hawary et al. 2014, DOI 10.1148/radiol.13131184, vessel reporting consensus.
- **locally-advanced**: Lee SS, Kim DW, Lee W, Kim KP. Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability (2026) — https://pmc.ncbi.nlm.nih.gov/articles/PMC13333231/ · Lee et al. 2026, PMC13333231, Table 1 locally advanced criteria and post-NAT section; Chu and Fishman 2023, PMC11486980, Table 1 greater-than-180-degree and unreconstructible-vein thresholds; Moir et al. 2023, PMC11203077, center-dependent resectability and objective vessel reporting.
- **metastatic**: Lee SS, Kim DW, Lee W, Kim KP. Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability (2026) — https://pmc.ncbi.nlm.nih.gov/articles/PMC13333231/ · Lee et al. 2026, PMC13333231, comprehensive distant-staging and treatment context; ACR Appropriateness Criteria revised 2025, locoregional and distant assessment variants; Moir et al. 2023, PMC11203077, template Part A metastatic sites and indeterminate post-treatment findings.

## Referências cruzadas
- _fronteira compartilhada_ → [Fukuoka IPMN — Fukuoka international consensus imaging features for intraductal papillary mucinous neoplasm](https://radcommons.laudos.ai/systems/fukuoka-ipmn.md) — Both are pancreatic cross-sectional reporting frameworks, but PDAC resectability maps a suspected or confirmed solid ductal adenocarcinoma and Fukuoka stratifies IPMN. Never apply PDAC vessel-contact labels to a cystic lesion without the correct diagnosis.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-06-04 | revised | A current radiology review integrated anatomic, biologic and conditional resectability and the post-neoadjuvant fibrosis limitation; it did not create a new universal treatment algorithm. | confirmed |
| 2025-02-13 | revised | NCCN Pancreatic Adenocarcinoma version 2.2025 was the named criteria version used in the current imaging review; the implementation retains objective vessel observations because criteria and center capability can change. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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