Management of Borderline Resectable Pancreatic Cancer

Abstract

Conventional definitions of resectability for pancreatic cancer would suggest that approximately 20 % are suitable for resection. Over recent years, the concept of borderline resectable pancreatic cancer (BRPC) has evolved to describe the cohort comprising around 25 % of patients with tumors involving either the portovenous confluence or mesenteric arteries in which a curative resection is technically feasible. The technical feasibility should correspond with acceptable perioperative and oncologic outcomes, both of which may be improved with neoadjuvant therapy. It is crucial that high quality cross-sectional imaging be performed during the evaluation, and that patients fitting internationally accepted criteria for BRPC be discussed in a multidisciplinary setting where neoadjuvant therapy should be considered. In order to comprehensively evaluate outcomes, and allow comparison with other contemporary series, an adopted standardized system of intra-operative evaluation and vascular resection is required. It is also of great importance that a standardized means of pathological assessment of resected specimens be used to allow accurate definition of curative resections in the technically challenging BRPC cohort.