Current Treatment Options in Gastroenterology

, Volume 8, Issue 5, pp 377–384 | Cite as

Borderline resectable pancreatic cancer

  • Gauri R. Varadhachary
  • Eric P. Tamm
  • Christopher Crane
  • Douglas B. Evans
  • Robert A. Wolff

Opinion statement

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.


Pancreatic Cancer Superior Mesenteric Artery National Comprehensive Cancer Network National Comprehensive Cancer Network Superior Mesenteric Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Gauri R. Varadhachary
    • 1
  • Eric P. Tamm
  • Christopher Crane
  • Douglas B. Evans
  • Robert A. Wolff
  1. 1.Department of Gastrointestinal Medical OncologyM.D. Anderson Cancer CenterHoustonUSA

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