Selection strategy of neoadjuvant therapy for pancreatic cancer

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Pancreatic cancer is a common malignancy with the worst prognosis. Radical surgery has been the only curative treatment for pancreatic cancer. With the advancement of surgical techniques and the implementation of the concept of comprehensive treatment for cancer in recent years, neoadjuvant therapy for pancreatic cancer has received more attention. There are continuing controversies in the hotspots and difficulties, with opportunities and challenges coexisting. Four famous experts and their teams in pancreatic surgery discussed selection strategy of neoadjuvant therapy for pancreatic cancer based on clinical experiences. Professor Wang Chunyou proposed that surgery was prior for patients with a higher likelihood of achieving R0 resection for pancreatic cancer to avoid the possibility of tumor progression and loss the opportanity of radical resection during neoadjuvant therapy. For patients with less chance of radical resection for pancreatic cancer and unresectable pancreatic cancer, neoadjuvant therapy is worthy of a positive attempt. Professor Jin Gang and his team believed that neoadjuvant therapy played an important role in improving the survival time of patients with pancreatic head cancer, especially with borderline resectable pancreatic head cancer. After neoadjuvant therapy, pancreatic surgeons should pay attention to improvement of surgery safety and R0 resection rate. Professor Dai Menghua and his team suggested that patients with resectable pancreatic cancer and borderline resectable pancreatic cancer could benefit from neoadjuvant therapy, which required proof from clinical trials. Surgeons should choose the appropriate treatment strategy based on guidelines and individual conditions for patients with pancreatic cancer. Professor Shao Cheghao and his team suggested that surgical treatment after neoadjuvant therapy or translational therapy for locally advanced pancreatic head cancer is safe, effective and feasible, especially for pancreaticoduodenectomy with combined revascularization. For the treatment of patients with pancreatic head cancer after neoadjuvant chemotherapy, the choice of next treatment options, evaluation indicators, timing of surgery and surgical methods need to be further studied. Key words: Pancreatic neoplasms; Pancreatic cancer; Pancreatic head neoplasms; Pancreatic head cancer; Neoadjuvant therapy; Surgical procedures, operative