Since then the criteria have been extended to include additional patients where the surgery could prove to be technically challenging. The American hepato-pancreatico-biliary (AHPBA) association consensus conference on pancreatic cancer (2009) expanded the venous involvement criteria to allow tumor abutment

of the Inhibitors,research,lifescience,medical SMV/PV with or without impingment and narrowing of the lumen (in addition to venous encasement or short segment occlusion). NCCN has adopted some of these AHPBA guidelines in its most recent version (2.2011) and selleck chemical allows SMV/portal vein abutment with impingment and narrowing of the lumen (13)-(16). The criteria for arterial involvement (SMA and hepatic artery) are clear and similar across the board. The above definitions describe the anatomic subset of borderline resectability

that deal only with tumor-vessel orientation (referred to as type Inhibitors,research,lifescience,medical A). Katz and colleagues have described two additional subsets, types B and C, which attempt to Inhibitors,research,lifescience,medical define additional criteria for borderline resectability beyond the imaging based principles (17). Most physicians encounter patients with operable pancreatic cancer who are not quite ready for immediate Inhibitors,research,lifescience,medical surgery and require extra time off to sort out host or tumor related concerns. Some of these patients have subtle indeterminate subcentimeter liver lesions or peritoneal / omental nodules that are suspicious for metastatic disease they are too small to proceed with a diagnostic FNA- biopsy or additional Inhibitors,research,lifescience,medical imaging tests (PET-CT or MRI). These patients fit the MDACC type B definition of borderline resectable pancreatic cancer. Type B patients

may have had a technically resectable or a borderline resectable primary tumor as defined on CT images. Electron transport chain Another subset of patients is those who have associated medical comorbidities that need time to evaluate or a reversible borderline performance status (typically ECOG 3). Good examples of these presentation is a patient who has a small asymptomatic pulmonary embolism on routine imaging or a patient with a low prealbumin and decline in nutrition and performance status in the presence of obstructive jaundice and cholangitis though progress is noted after biliary decompression and a close eye on nutritional supplementation. This subset constitutes Type C category (and patients in this category may also have had a radiographic potentially resectable or a borderline resectable primary tumor).