The algorithm above assumes that patients are appropriate candidates for surgery. Patients who are poor surgical candidates may be treated with systemic chemotherapy only.
CT: computed tomography. * Adjuvant chemotherapy is administered specifically for those with stage IC or II disease, clear cell histology (any grade), or high tumor grade. ¶ Most experts agree that patients with any of the following criteria have unresectable disease:
Diffuse and/or deep infiltration of the small bowel mesentery
Diffuse carcinomatosis involving the stomach and/or large parts of the small or large bowel
Infiltration of the duodenum and/or parts of the pancreas (not limited to the pancreatic tail)
Involvement of the large vessels of the hepatoduodenal ligament, celiac trunk, or behind the porta hepatis
Involvement of the liver parenchyma
Lung metastases
Lymph node metastases in axilla or mediastinum
Δ Some UpToDate experts administer 6 cycles post-surgery (rather than 3), except in verified stage I/II disease.
Graphic 131639 Version 1.0
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