Pancreatic Cancer pp 1001-1020 | Cite as

Borderline Resectable Pancreatic Cancer

  • Gauri R. Varadhachary
Reference work entry


Rigorous criteria are essential to define resectability of PDAC, which allows for accurate pretreatment staging and planning stage-specific therapy. Tumors of borderline resectability have emerged as a distinct subset, and these patients are at a high risk for margin positive resection. The intergroup criteria for BRPC includes: (1) an interface between the tumor and SMV–PV ≥180° of the vein circumference; (2) short-segment occlusion of the SMV–PV with normal vein above and below the obstruction amenable to resection and reconstruction; (3) short-segment interface of any degree between tumor and HA with normal artery proximal and distal to the interface amenable to arterial resection and reconstruction; and (4) interface between the tumor and SMA and/or CA measuring <180° of the circumference of the artery. Two multicytotoxic regimens approved for metastatic disease, 5-flurouracil with oxaliplatin and irinotecan (FOLFIRINOX) and gemcitabine with nab-paclitaxel (Gem-nabP), are incorporated in the preoperative management of BRPC in many centers although high-level evidence data on these regimens in the neoadjuvant setting are not yet available. Those with radiographic stability or regression and an improvement in serum tumor markers (CA19-9) may proceed to pancreatectomy and may require vascular resection and reconstruction. Prospective clinical trials with well-defined eligibility will help determine the treatment strategies. Additionally, prognostic and predictive biomarkers are urgently needed in therapy planning.


Pancreatic adenocarcinoma preoperative chemotherapy neoadjuvant borderline resectable biomarkers 


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastrointestinal Medical OncologyUniversity of Texas, M.D. Anderson Cancer CenterHoustonUSA

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