Patient Data
A large heterogeneous mass arising from the head of the pancreas is present which abuts the superior mesenteric artery over more than 180 degrees and results in narrowing. The upper aspect of the superior mesenteric vein and origin of the main portal vein are also stenosed.
A biliary stent is in situ with associated pneumobilia. The main pancreatic duct is markedly dilated and pancreatic parenchyma is atrophic. Numerous enlarged retroperitoneal nodes are present.
Case Discussion
This case illustrates T4 pancreatic cancer. The vascular criteria for unresectability vary from country to country and surgeon to surgeon, but generally it is accepted that SMA with tumor encasement >180 degrees circumference (which this case has, with associated narrowing) is unresectable. A coronal would probably be better to demonstrate it. The portal vein at the origin is very narrow... combined with the SMA involvement would make it unresectable.
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