Pancreatic Adenocarcinoma Diagnosed
Biopsy-proven or highly suspicious imaging
All Pathways
Hepatobiliary SurgeryDiagnostic
Pancreatic Cancer Resectability Assessment - NCCN 2024
Pancreatic Cancer Resectability Assessment - NCCN 2024: Pancreatic Adenocarcinoma Diagnosed → Staging Workup → Distant Metastases? → Metastatic Disease ...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Staging Workup
Pancreas protocol CT, CA 19-9, staging laparoscopy
- High-quality CT with arterial/venous phases
- Assess SMA, celiac, SMV, portal vein
- Check for liver mets, peritoneal disease
03Decision Distant Metastases?
- Liver mets
- Peritoneal implants
- Distant lymph nodes
- Positive peritoneal cytology
04Action Metastatic Disease
Systemic therapy
- FOLFIRINOX or gem/nab-paclitaxel
- Palliative care integration
- Biliary stent if obstructed
05End Adjuvant Therapy & Surveillance
Complete 6 months perioperative chemo, surveillance CT/CA 19-9
06Decision Vascular Involvement (NCCN)
- Resectable: no arterial contact, no/minimal venous contact
- Borderline: venous involvement or limited arterial abutment
- Locally Advanced: unreconstructable venous or arterial encasement
07Action Resectable
No vascular involvement or reconstructable
08Action Upfront Surgery
If excellent PS, no high-risk features
09Action Surgical Resection
Whipple or distal pancreatectomy
- High-volume center preferred
- Vascular resection if needed
- R0 resection goal
- Path rejoins step 05Shared downstream outcome
10Action Neoadjuvant Therapy
FOLFIRINOX or gem-based
- 2-4 months of chemo ± RT
- Restaging CT after treatment
- Proceed to surgery if no progression
- Path rejoins step 09Shared downstream outcome
11Action Borderline Resectable
May be resectable after neoadjuvant
- SMV/PV involvement with reconstruction possible
- SMA abutment ≤180°
- GDA encasement up to hepatic artery
- Path rejoins step 10Shared downstream outcome
12Action Locally Advanced
Not currently resectable
- SMA/celiac encasement >180°
- Unreconstructable SMV/PV
- Aortic invasion
13Action Induction Therapy
Goal: convert to resectable
- FOLFIRINOX preferred if tolerated
- SBRT or chemoRT
- Reassess for resectability
- Path rejoins step 09Shared downstream outcome
- Path rejoins step 04Shared downstream outcome
Guideline Source
NCCN Guidelines - Pancreatic Adenocarcinoma Version 1.2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Vascular involvement definitions have evolved
- Response to neoadjuvant may convert borderline to resectable
- Arterial involvement generally precludes resection
- High-volume centers have better outcomes
Applicable Regions
USAUUKEU
EU: ESMO pancreatic cancer guidelines
US: NCCN resectability criteria
Version 1Next review: 2028-01-01
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Related Resources
Frequently Asked Questions
What is the Pancreatic Cancer Resectability Assessment - NCCN 2024?
The Pancreatic Cancer Resectability Assessment - NCCN 2024 is a diagnostic clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on NCCN Guidelines - Pancreatic Adenocarcinoma Version 1.2024.
What guideline is the Pancreatic Cancer Resectability Assessment - NCCN 2024 based on?
This algorithm is based on NCCN Guidelines - Pancreatic Adenocarcinoma Version 1.2024 (DOI: 10.6004/jnccn.2024.0020).
What are the limitations of the Pancreatic Cancer Resectability Assessment - NCCN 2024?
Known limitations include: Vascular involvement definitions have evolved; Response to neoadjuvant may convert borderline to resectable; Arterial involvement generally precludes resection; High-volume centers have better outcomes. Individual patient factors may require deviation from these recommendations.
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