Preoperative nonresectability criteria used for pancreatic head adenocarcinoma: a practical survey among gastroenterologists and surgeons. Société Française de Chirurgie Digestive.

Preoperative nonresectability criteria for carcinoma of the pancreatic head remain controversial. We sought to assess prospectively the preoperative criteria used currently in clinical practice and to determine the different therapeutic strategies used between gastroenterologists (GEs) and digestive surgeons (Ss). The evaluation comprised all of the registered GEs (n = 3,466) and Ss (n = 687) who were sent a questionnaire surveying nonresectability criteria. The hypothesis in question concerned adenocarcinoma of the pancreatic head in a patient in the absence of general operative contraindication. Six hundred fifteen complete responses to the questionnaire were received (GEs, 426; Ss, 189). The mean estimated percentage of resected tumor was 22% (GEs, 19%; Ss, 31%; p < 0.0001). Preoperative nonresectability criteria differed between the two groups and included weight loss >25% (percentage of GEs using this criterion, 57%; Ss, 48%; p < 0.04), duodenal wall invasion (GEs, 30%; Ss, 4%; p < 0.001), gastric extension (GEs, 55%; Ss, 23%; p < 0.001), invasion of gastroduodenal artery (GEs, 58%; Ss, 19%; p < 0.001), invasion of superior mesenteric artery (GEs, 85%; Ss, 92%; p < 0.02), invasion of portal vein (GEs, 78%; Ss, 52%; p < 0.001), tumor diameter >6 cm (GEs, 52%; Ss, 38%; p < 0.001), peripancreatic lymph nodes (GEs, 33-69% depending on the node area; Ss, 5-52%; p < 0.02-0.001). Consensual criterion used by >85% of GEs and Ss was celiac trunk invasion. Criteria rejected by >85% both of GEs and Ss were back pain, weight loss <25%, and tumor diameter < or = 5 cm. Criteria without consensus (used or rejected by <85% of GEs and Ss) were superior mesenteric vein and hepatic artery invasion. The preoperative nonresectability criteria used in determining operative resectability differs significantly between medical and surgical gastroenterologists. This study is the first to quantify this difference. These results underline the need for consensus agreement in the criteria of resectability.