# Resectable, borderline resectable and unresectable

Source: https://onco.cc/terms/resectability/  
OnCo record `resectability` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The surgeon's verdict on whether the tumour can be completely removed. Resectable means yes; unresectable means it has wrapped around vital vessels, is too extensive or the patient is too frail; borderline means maybe, especially after chemotherapy shrinks it.

## Summary

Resectability is judged on imaging by involvement of arteries and veins (pancreatic cancer's borderline definitions concern the superior mesenteric vessels), extent of nodal disease (N2-3 in lung cancer) and liver remnant volume, and is not the same as stage: some stage IV colorectal liver metastases are resectable and some stage II pancreatic tumours are not. Unresectable does not mean incurable: stage III lung cancer is cured by chemoradiation plus durvalumab in a third of patients, and 'conversion therapy' (FOLFOXIRI-bevacizumab in liver metastases, RAS inhibitors in pancreatic cancer) turns some unresectable cancers into resectable ones. Multidisciplinary review is required because surgeons differ in what they will attempt.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: resectable; resectability; unresectable; non-resectable; inoperable; operable; borderline resectable; borderline-resectable; potentially resectable; initially unresectable; upfront surgery; upfront resection; conversion to resectability; conversion surgery; downstaged

## Notes

- For pancreatic cancer the classes are defined in degrees of vessel contact on a pancreas protocol CT, with biological (CA 19-9 above 500 U/mL, suspected spread) and conditional (performance status) dimensions added by the 2017 international consensus (Isaji 2018); the pancreatic glossary term sets them out.
- Pancreatic cancer: Cancer Research UK explains the three words in plain English (resectable: the surgeon can remove it; borderline resectable: it may involve a main blood vessel, so chemotherapy first is common; unresectable: locally advanced or metastatic). Pancreatic Cancer UK says different teams can read the scan differently and you can ask for a second opinion; NICE NG85 says neoadjuvant treatment for resectable or borderline disease should be within a clinical trial.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Segmental_resection
- Wikipedia: https://en.wikipedia.org/wiki/Segmental_resection
- Isaji, Pancreatology 2018: international consensus on the definition and criteria of borderline resectable pancreatic cancer: https://doi.org/10.1016/j.pan.2017.11.011
- Tempero, JNCCN 2021: NCCN pancreatic adenocarcinoma guidelines, version 2.2021: https://doi.org/10.6004/jnccn.2021.0017
- Cancer Research UK: treatment options for pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/treatment-decisions
- Pancreatic Cancer UK: who can have surgery for pancreatic cancer?: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/who-can-have-surgery/
- NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations

## Connected records

- terms: [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Downstaging and conversion therapy](https://onco.cc/terms/downstaging/), [Locally advanced and locoregional disease](https://onco.cc/terms/locally-advanced/), [Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer](https://onco.cc/terms/neoadjuvant-versus-upfront-surgery-pancreatic/), [Pancreatic cancer trials open today (registry snapshot and UK sites)](https://onco.cc/terms/pancreatic-trials-open-today/), [Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)](https://onco.cc/terms/nccn-resectability-criteria-pancreatic/), [Resectability in lung cancer](https://onco.cc/terms/resectability-lung-cancer/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)](https://onco.cc/terms/vascular-resection-pancreatic/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)
- technologies: [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/)
- cancers: [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- key papers: [Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial](https://onco.cc/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/), [Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial](https://onco.cc/key-papers/paper-preopanc-preoperative-chemoradiotherapy-jco-2020/), [Treatment of carcinoma of the ampulla of Vater](https://onco.cc/key-papers/paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed](https://onco.cc/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/)
- trials: [Alliance A021501](https://onco.cc/trials/alliance-a021501/), [Alliance A021806](https://onco.cc/trials/alliance-a021806/), [CONKO-007](https://onco.cc/trials/conko-007/), [NEOLAP](https://onco.cc/trials/neolap/), [SWOG S1505](https://onco.cc/trials/swog-s1505/)

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