Pancreatic Cancer · Resectability + Approach

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Resectability (vascular involvement) + metastasis
   Degree of vascular involvement? Metastasis?
   • Resectable (no major vascular involvement) → Resectable → surgery + adjuvant
   • Borderline resectable (limited SMV/PV or arterial abutment) → Borderline → reassess after neoadjuvant
   • Locally advanced unresectable (arterial encasement) → Locally advanced → systemic therapy
   • Metastatic → Metastatic → palliative
2. [End] Resectable → surgery + adjuvant
   Resectable → surgical resection (pancreatic head: Whipple pancreaticoduodenectomy; body/tail: distal pancreatectomy ± splenectomy) + adjuvant chemotherapy; some centers favor neoadjuvant first. Stent/drain biliary obstruction first.
3. [End] Borderline → reassess after neoadjuvant
   Borderline resectable → neoadjuvant chemotherapy (FOLFIRINOX/gemcitabine-nab-paclitaxel) ± radiotherapy then reassess; surgery if downstaged/no progression; multidisciplinary decision.
4. [End] Locally advanced → systemic therapy
   Locally advanced unresectable (arterial encasement) → systemic therapy ± radiotherapy; palliate obstruction (biliary/duodenal stent), pain and nutrition.
5. [End] Metastatic → palliative
   Metastatic → palliative chemotherapy + symptom management (biliary/duodenal obstruction stenting, pain ladder/celiac plexus block, nutritional support).

Source guidelines & references

• Pancreatic cancer resectability and management (NCCN; resectable/borderline/locally advanced definitions)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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