{"entity":{"id":"resectability","kind":"term","name":"Resectable, borderline resectable and unresectable","aka":["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"],"tldr":"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.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Segmental_resection","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Segmental_resection"},{"label":"Isaji, Pancreatology 2018: international consensus on the definition and criteria of borderline resectable pancreatic cancer","url":"https://doi.org/10.1016/j.pan.2017.11.011"},{"label":"Tempero, JNCCN 2021: NCCN pancreatic adenocarcinoma guidelines, version 2.2021","url":"https://doi.org/10.6004/jnccn.2021.0017"},{"label":"Cancer Research UK: treatment options for pancreatic cancer","url":"https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/treatment-decisions"},{"label":"Pancreatic Cancer UK: who can have surgery for pancreatic cancer?","url":"https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/who-can-have-surgery/"},{"label":"NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations","url":"https://www.nice.org.uk/guidance/ng85/chapter/Recommendations"}],"tags":[],"related":["locally-advanced","resection-margins","downstaging","multidisciplinary-tumour-board","whipple"],"cancers":["pancreatic","resectable-pdac","borderline-resectable-pdac","locally-advanced-pdac","nsclc","colorectal","hcc"],"sections":["surgery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["nccn-resectability-criteria-pancreatic","vascular-resection-pancreatic","neoadjuvant-versus-upfront-surgery-pancreatic"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"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."],"category":"Treatment jargon"},"route":"/terms/resectability/","neighbours":{"term":[{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"},{"id":"downstaging","kind":"term","name":"Downstaging and conversion therapy","route":"/terms/downstaging/"},{"id":"locally-advanced","kind":"term","name":"Locally advanced and locoregional disease","route":"/terms/locally-advanced/"},{"id":"neoadjuvant-versus-upfront-surgery-pancreatic","kind":"term","name":"Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer","route":"/terms/neoadjuvant-versus-upfront-surgery-pancreatic/"},{"id":"pancreatic-trials-open-today","kind":"term","name":"Pancreatic cancer trials open today (registry snapshot and UK sites)","route":"/terms/pancreatic-trials-open-today/"},{"id":"nccn-resectability-criteria-pancreatic","kind":"term","name":"Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)","route":"/terms/nccn-resectability-criteria-pancreatic/"},{"id":"resectability-lung-cancer","kind":"term","name":"Resectability in lung cancer","route":"/terms/resectability-lung-cancer/"},{"id":"resection-margins","kind":"term","name":"Resection margins (R0 / R1 / R2)","route":"/terms/resection-margins/"},{"id":"vascular-resection-pancreatic","kind":"term","name":"Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)","route":"/terms/vascular-resection-pancreatic/"},{"id":"whipple","kind":"term","name":"Whipple procedure (pancreaticoduodenectomy)","route":"/terms/whipple/"}],"technology":[{"id":"multidisciplinary-tumour-board","kind":"technology","name":"Multidisciplinary tumour boards","route":"/technologies/multidisciplinary-tumour-board/"}],"cancer":[{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal adenocarcinoma","route":"/cancers/borderline-resectable-pdac/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"},{"id":"ipmn-cystic-precursors","kind":"cancer","name":"Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors","route":"/cancers/ipmn-cystic-precursors/"},{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"paper":[{"id":"paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025","kind":"paper","name":"Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial","route":"/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/"},{"id":"paper-preopanc-preoperative-chemoradiotherapy-jco-2020","kind":"paper","name":"Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial","route":"/key-papers/paper-preopanc-preoperative-chemoradiotherapy-jco-2020/"},{"id":"paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935","kind":"paper","name":"Treatment of carcinoma of the ampulla of Vater","route":"/key-papers/paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935/"}],"roadmap":[{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}],"idea":[{"id":"idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease","kind":"idea","name":"Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed","route":"/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/"}],"trial":[{"id":"alliance-a021501","kind":"trial","name":"Alliance A021501","route":"/trials/alliance-a021501/"},{"id":"alliance-a021806","kind":"trial","name":"Alliance A021806","route":"/trials/alliance-a021806/"},{"id":"conko-007","kind":"trial","name":"CONKO-007","route":"/trials/conko-007/"},{"id":"neolap","kind":"trial","name":"NEOLAP","route":"/trials/neolap/"},{"id":"swog-s1505","kind":"trial","name":"SWOG S1505","route":"/trials/swog-s1505/"}]}}