Borderline resectable pancreatic cancer
Rigorous criteria to define "borderline resectable" pancreatic cancer are required for appropriate patient accrual into clinical trials that examine the utility of chemotherapy and/or chemoradiation that will be delivered prior to pancreatic resection for exocrine cancer. At our institution, tumor abutment of less than or equal to 180 degrees (≤ 50% of the vessel circumference) of the superior mesenteric artery, short segment abutment or encasement (≥50% of the vessel circumference) of the common hepatic artery (typically at the gastroduodenal artery origin), or segmental venous occlusion are used to categorize a pancreatic tumor as borderline resectable. These patients are at a high risk for margin positive resection with initial surgery; therefore, we favor a treatment schema that incorporates preoperative (neoadjuvant) therapy with systemic chemotherapy and chemoradiation. Patients whose tumors show radiographic stability or regression that are often accompanied by an improvement in serum tumor markers are candidates for pancreaticoduodenectomy. A prospective multicenter clinical trial with well-defined eligibility criteria may help decide the best overall treatment strategy for these patients. Vascular resection and reconstruction may be required in patients with borderline resectable tumors, and surgery should be performed at centers with expertise in such complex pancreatic resections.
KeywordsPancreatic Cancer Superior Mesenteric Artery National Comprehensive Cancer Network National Comprehensive Cancer Network Superior Mesenteric Vein
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References and Recommended Reading
- 2.Wolff RA, Abbruzzese JL, Evans DB, eds: Neoplasms of the exocrine pancreas. In Cancer Medicine, edn. 2. Edited by Bast Jr. RC, Kufe DW, Pollock RE, et al. Hemilton, Ontario: American Cancer Society and B.C. Decker, Inc.; 2003: 1585–1614.Google Scholar
- 15.Greene FL, Page DL, Fleming ID, et al.: AJCC Cancer Staging Manual, edn 6. New York: Springer-Verlag; 2002.Google Scholar
- 16.Tseng JF, Raut CP, Lee JE, et al.: Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004, 8: 935–950. This is the largest study to date on vascular resection at the time of pancreaticoduodenectomy and compares the outcome of patients who underwent vascular resection with patients who underwent standard pancreaticoduodenectomy.PubMedCrossRefGoogle Scholar
- 21.National Comprehensive Cancer Network (NCCN) Practice Guidelines for Pancreatic Cancer, 2004.Google Scholar