Korean J Pancreas Biliary Tract.  2026 Apr;31(2):37-41. 10.15279/kpba.2026.31.2.37.

When Should We Refer for Conversion Surgery in Pancreatic Cancer? The Gastroenterologist’s Perspective

• Jang DK

• KMID: 2580461
• DOI: http://doi.org/10.15279/kpba.2026.31.2.37

Abstract

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis, with approximately 80% of patients presenting with unresectable disease at the time of diagnosis. However, with the recent introduction of effective chemotherapy regimens such as FOLFIRINOX and gemcitabine+nab-paclitaxel (GnP), conversion surgery has become feasible in selected patients with initially unresectable locally advanced pancreatic cancer. Recent large-scale studies from Japan have demonstrated that patients undergoing conversion surgery achieve a 5-year overall survival rate of 37.2%, offering new hope for patients with advanced pancreatic cancer. Although various studies have proposed multiple criteria for referral to conversion surgery, standardization has not yet been established, and individualized patient assessment remains important. The most appropriate approach is to proceed with conversion surgery after at least 6 months of adequate neoadjuvant chemotherapy when imaging demonstrates surgical resectability, tumor markers have sufficiently decreased, and multidisciplinary evaluation confirms the patient's fitness for surgery. Preoperative chemotherapy with FOLFIRINOX has been shown to provide superior survival outcomes compared to GnP, and maintaining the same chemotherapy regimen as adjuvant therapy following surgical resection is recommended. The anticipated results from the ongoing PREOPANC-4 study in the Netherlands are expected to provide important standardized guidelines for surgical management of locally advanced pancreatic cancer.

Keyword

Pancreatic neoplasms; Surgery; Neoadjuvant chemotherapy; 췌장암; 수술; 수술전항암치료