Indications and Contraindications

General Principles ■ We advocate objective, anatomic criteria for defining resectability based on high quality CT images.

■ Local tumor resectability [relationship of the neoplasm to the celiac axis, superior mesenteric artery (SMA) and superior mesenteric-portal vein (SMPV) confluence] cannot be determined accurately at laparotomy before gastric and pancreatic transection; thus, preoperative assessment of critical tumor-vessel relationships is mandatory.

Indications ■ Resectable neoplasms have the following CT characteristics:

- Normal fat plane between the low-density tumor and the superior mesenteric artery and superior mesenteric vein (SMV)

- Absence of extrapancreatic disease

- Patent SMPV confluence (assumes ability of the surgeon to resect and reconstruct isolated segments of the SMV or SMPV)

- No direct tumor extension to the celiac axis or SMA ■ "Borderline" resectable neoplasms include:

- Short segment occlusion of the SMPV confluence with an adequate vessel for grafting above and below the site of occlusion (assumes the technical ability to resect and reconstruct the SMV or SMPV)

- Neoplasms which demonstrate short-segment (usually <1cm) abutment of the common or proper hepatic artery or the SMA on high-quality CT

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