Abstract
Borderline resectable pancreatic adenocarcinoma (PDAC) presents challenges in definition and treatment. Many different definitions exist for this disease. Some are based on anatomy alone, while others include factors such as disease biology and patient performance status. Regardless of definition, evidence suggests that borderline resectable PDAC is a systemic disease at the time of diagnosis. There is high-level evidence to support the use of neoadjuvant systemic therapy in these cases. Evidence to support the use of radiation therapy is ongoing. There are ongoing trials investigating the available neoadjuvant therapies for borderline resectable PDAC that may provide clarity in the future.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy
This finding led to pancreatic specialists attempting to determine which PDAC patients would benefit from neoadjuvant therapy prior to resection, in order to increase the rate of R0 margins and decrease node positivity [5,6]
The individual contributions as well as the combination of computed tomography (CT) and Endoscopic ultrasounds (EUS) have been examined in regards to their discriminative ability to predict vascular involvement, in the setting of neoadjuvant therapy. Both modalities have higher sensitivity and low specificity for identifying venous invasion and close resection margins (
Summary
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy. While it is the 14th most common cancer worldwide, PDAC is the seventh leading cause of cancer deaths [1]. A correlation of R0 resection and node negative pathology with improved survival was demonstrated in patients who underwent resection [2,3,4] This finding led to pancreatic specialists attempting to determine which PDAC patients would benefit from neoadjuvant therapy prior to resection, in order to increase the rate of R0 margins and decrease node positivity [5,6]. This consideration fostered the preoperative categorization of PDAC into resectable, borderline resectable, locally advanced, and metastatic disease, for investigative purposes.
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