This allows the appropriate candidates suited for surgery to proceed with PD. This article reviews the definition of borderline resectable tumors and provides a framework for preoperative therapeutic options of patients with resectable and borderline resectable pancreatic cancers. Preoperative staging criteria and the customer reviews changing paradigm A multidetector computerized tomography (MDCT) with 3-dimensional reconstruction is the best modality to determine local tumor resectability except for its low sensitivity for low-volume

hepatic or peritoneal metastases (in~20% of patients, CT occult metastatic Inhibitors,research,lifescience,medical disease is found on laparoscopy or exploration)

(9)-(11). Whenever possible, it is helpful to perform a CT scan prior to biliary decompression procedures since Inhibitors,research,lifescience,medical post-procedure pancreatitis, if it occurs, may obliterate the vascular planes and preclude accurate assessment of the extent of disease. Endoscopic ultrasound (EUS) has a higher sensitivity compared to a CT scan to detect small tumors and is indicated in selected patients especially those who are candidates for preoperative therapy. The American Joint Committee on Cancer (AJCC) TNM (Tumor, Inhibitors,research,lifescience,medical Nodes, Metastasis) staging for pancreatic cancer was revised in 2002 (6th Inhibitors,research,lifescience,medical edition), to reflect the fact local tumor resectability can be determined by high quality CT imaging and these criteria are unchanged in the latest AJCC edition (12). Based on the AJCC criteria, patients with stages 3 and 4 pancreatic adenocarcinoma are considered to have unresectable disease. Criteria for resectability include the Inhibitors,research,lifescience,medical absence of tumor extension to the the celiac artery (CA) and superior mesenteric artery (SMA), a patent superior mesenteric

vein (SMV) and portal vein (PV), and no distant metastases. Locally advanced, surgically unresectable tumors are defined as those that encase the adjacent arteries (celiac axis, SMA, common hepatic artery) or that occlude the SMV, PV, or SMPV confluence. With sophisticated imaging, there is a paradigm shift and a growing category AV-951 of borderline resectability and the attempt to standardize the definition of borderline resectable pancreatic cancer is work in progress, being modified with time. Borderline resectable criteria: NCCN, MDACC and AHPBA guidelines Even though there is some consistency in the AJCC definitions of resectability, these become blurred when describing borderline resectable pancreatic adenocarcinoma. At the University of Texas M.D.