Skip to main content

Advertisement

SpringerLink
Log in

Borderline resectable pancreatic cancer

  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Jemal A, Murray T, Ward E, et al.: Cancer statistics. CA Cancer J Clin 2005, 55: 10–30.

    Article  PubMed  Google Scholar 

  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 

  3. Li D, Xie K, Wolff R, et al.: Pancreatic cancer. Lancet 2004, 363: 1049–1057.

    Article  PubMed  CAS  Google Scholar 

  4. Saldinger PF, Reilly M, Reynolds K, et al.: Is CT angiography sufficient for prediction of resectability of periampullary neoplasms [discussion 238–239]? J Gastrointest Surg 2000, 4: 233–237.

    Article  PubMed  CAS  Google Scholar 

  5. Tamm E, Charnsangavej C, Szklaruk J: Advanced 3-D imaging for the evaluation of pancreatic cancer with multidetector CT. Int J Gastrointest Cancer 2001, 30: 65–71.

    Article  PubMed  CAS  Google Scholar 

  6. Faria SC, Tamm EP, Loyer EM, et al.: Diagnosis and staging of pancreatic tumors. Semin Roentgenol 2004, 39: 397–411. This paper discusses CT imaging criteria for staging pancreatic cancer.

    Article  PubMed  Google Scholar 

  7. Kulig J, Popiela T, Zajac A, et al.: The value of imaging techniques in the staging of pancreatic cancer. Surg Endosc 2005, 19: 361–365.

    Article  PubMed  CAS  Google Scholar 

  8. Pisters PW, Lee JE, Vauthey JN, et al.: Laparoscopy in the staging of pancreatic cancer. Br J Surg 2001, 88: 325–337.

    Article  PubMed  CAS  Google Scholar 

  9. Schmidt J, Fraunhofer S, Fleisch M, et al.: Is peritoneal cytology a predictor of unresectability in pancreatic carcinoma? Hepatogastroenterology 2004, 51: 1827–1831.

    PubMed  Google Scholar 

  10. Zhao ZW, He JY, Tan G, et al.: Laparoscopy and laparoscopic ultrasonography in judging the resectability of pancreatic head cancer. Hepatobiliary Pancreat Dis Int 2003, 2: 609–611.

    PubMed  Google Scholar 

  11. Chen VK, Arguedas MR, Kilgore ML, et al.: A costminimization analysis of alternative strategies in diagnosing pancreatic cancer. Am J Gastroenterol 2004, 99: 2223–2234.

    Article  PubMed  Google Scholar 

  12. Levy MJ, Wiersema MJ: Pancreatic neoplasms. Gastrointest Endosc Clin N Am 2005, 15: 117–142.

    Article  PubMed  Google Scholar 

  13. Eloubeidi MA, Gress FG, Savides TJ, et al.: Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc 2004, 60: 385–389.

    Article  PubMed  Google Scholar 

  14. Raut CP, Grau AM, Staerkel GA, et al.: Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer [discussion 127–128]. J Gastrointest Surg 2003, 7: 118–126.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  17. Jarufe NP, Coldham C, Mayer AD, et al.: Favourable prognostic factors in a large UK experience of adenocarcinoma of the head of the pancreas and periampullary region. Dig Surg 2004, 21: 202–209.

    Article  PubMed  CAS  Google Scholar 

  18. Lim JE, Chien MW, Earle CC: Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 2003, 237: 74–85.

    Article  PubMed  Google Scholar 

  19. Neoptolemos JP, Stocken DD, Dunn JA, et al.: Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001, 234: 758–768.

    Article  PubMed  CAS  Google Scholar 

  20. Neoptolemos JP, Stocken DD, Friess H, et al.: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004, 350: 1200–1210.

    Article  PubMed  CAS  Google Scholar 

  21. National Comprehensive Cancer Network (NCCN) Practice Guidelines for Pancreatic Cancer, 2004.

  22. Loyer EM, David CL, Dubrow RA, et al.: Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT. Abdom Imaging 1996, 21: 202–206.

    Article  PubMed  CAS  Google Scholar 

  23. Lu DS, Reber HA, Krasny RM, et al.: Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 1997, 168: 1439–1443.

    PubMed  CAS  Google Scholar 

  24. White RR, Tyler DS: Neoadjuvant therapy for pancreatic cancer: the Duke experience. Surg Oncol Clin N Am 2004, 13: 675–684, ix-x.

    Article  PubMed  Google Scholar 

  25. Spitz FR, Abbruzzese JL, Lee JE, et al.: Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997, 15: 928–937.

    PubMed  CAS  Google Scholar 

  26. Breslin TM, Hess KR, Harbison DB, et al.: Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol 2001, 8: 123–132.

    Article  PubMed  CAS  Google Scholar 

  27. Yeo CJ, Cameron JL, Lillemoe KD, et al.: Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients [discussion 731–733]. Ann Surg 1995, 221: 721–731.

    Article  PubMed  CAS  Google Scholar 

  28. Millikan KW, Deziel DJ, Silverstein JC, et al.: Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas [discussion 623–624]. Am Surg 1999, 65: 618–623.

    PubMed  CAS  Google Scholar 

  29. Sohn TA, Yeo CJ, Cameron JL, et al.: Resected adenocarcinoma of the pancreas-616 patients results, bdoutcomes, and prognostic indicators. J Gastrointest Surg 2000, 4: 567–579.

    Article  PubMed  CAS  Google Scholar 

  30. Benassai G, Mastrorilli M, Quatro G, et al.: Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas. J Surg Oncol 2000, 73: 212–218.

    Article  PubMed  CAS  Google Scholar 

  31. Kuhlmann KF, de Castro SM, Wesseling JG, et al.: Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer 2004, 40: 549–558.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Medical Oncology, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, 77030, Houston, TX, USA

    Gauri R. Varadhachary MD

Authors
  1. Gauri R. Varadhachary MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric P. Tamm MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Crane MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Douglas B. Evans MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert A. Wolff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varadhachary, G.R., Tamm, E.P., Crane, C. et al. Borderline resectable pancreatic cancer. Curr Treat Options Gastro 8, 377–384 (2005). https://doi.org/10.1007/s11938-005-0040-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-005-0040-x

Keywords

Search

Navigation