Ann Hepatobiliary Pancreat Surg.  2019 May;23(2):97-108. 10.14701/ahbps.2019.23.2.97.

Contemporary management of borderline resectable pancreatic ductal adenocarcinoma

Affiliations
  • 1First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece. dgiak@auth.gr
  • 2Department of HPB Surgery, The Royal London Hospital, London, UK.

Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive tumors, with a low rate of survival, likely due to the tendency of the tumor for early local and distant spread. Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths. Surgical resection still represents the best curative treatment for PDAC, although only 10-20% of patients are upfront resectable at diagnosis, 50% has metastatic disease and 35% locally advanced cancer. The 5-year overall survival (OS) after curative resection is limited to 20%. Moreover among patients who undergo surgery, 30% develop early recurrence while most of them will eventually relapse. The risk of early failure after surgery could be associated with inadequate preoperative radiological staging, lack of radical surgery and differences in tumor aggressiveness. In recent years, more accurate patient categorization due to sophisticated imaging tools and techniques increase the survival rate while neoadjuvant treatment can help surgeons select patients who will benefit most from surgery. Neoadjuvant therapy includes chemotherapy alone, chemoradiotherapy, chemotherapy with chemoradiation and targeted therapies. The aim of this review is to present the available data concerning the management of patients with borderline PDAC.

Keyword

Pancreatic adenocarcinoma; Borderline resectable; Chemotherapy; Chemoradiation

MeSH Terms

Adenocarcinoma*
Chemoradiotherapy
Diagnosis
Drug Therapy
Humans
Neoadjuvant Therapy
Pancreatic Ducts*
Pancreatic Neoplasms
Recurrence
Surgeons
Survival Rate

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