From Surgical Boundaries to Oncological Benefit: Integrated Selection in High-Complexity Abdominal Malignancies

Résumé fourni par la source

Resectability in complex abdominal tumors has evolved from a predominantly anatomical concept into a dynamic assessment that integrates imaging, tumor biology, functional reserve, treatment response, and surgical capability. This study analyzed the principal criteria used to determine resectability in pancreatic tumors, primary hepatic malignancies, colorectal liver metastases, gastric and peritoneal tumors, and retroperitoneal sarcomas. A descriptive and analytical integrative review of 20 scientific publications was conducted using a structured scientific-method framework. Surgical strategy was addressed in 85% of the publications, tumor biology in 80%, advanced imaging in 75%, treatment response in 55%, and patient functional reserve in 45%. Contrast-enhanced computed tomography was the most frequently reported imaging modality, followed by magnetic resonance imaging, PET/CT, functional or volumetric imaging, and radiomics. Metastatic distribution and progression pattern were the most frequently incorporated biological factors, followed by histological subtype, tumor grade, response to systemic treatment, tumor-marker dynamics, and molecular alterations. Vascular resection and reconstruction represented the most frequently reported strategy for expanding resectability, followed by combined resection and ablation, multivisceral resection, staged procedures, future liver remnant augmentation, and transplantation. The findings demonstrate that anatomical removability alone is insufficient to define surgical eligibility. Resectability should be classified as immediately resectable, borderline resectable, potentially convertible, technically unresectable, biologically unresectable, or physiologically unresectable. Multidisciplinary reassessment is essential because the initial classification may change after systemic treatment, functional optimization, or advanced surgical planning. The final objective is to identify patients in whom complete local treatment can be achieved with acceptable morbidity, preserved function, and a reasonable probability of durable oncological benefit.

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