Contemporary Review of Borderline Resectable Pancreatic Ductal Adenocarcinoma

Abstract

Borderline resectable pancreatic adenocarcinoma (PDAC) presents challenges in definition and treatment. Many different definitions exist for this disease. Some are based on anatomy alone, while others include factors such as disease biology and patient performance status. Regardless of definition, evidence suggests that borderline resectable PDAC is a systemic disease at the time of diagnosis. There is high-level evidence to support the use of neoadjuvant systemic therapy in these cases. Evidence to support the use of radiation therapy is ongoing. There are ongoing trials investigating the available neoadjuvant therapies for borderline resectable PDAC that may provide clarity in the future.

Keywords: borderline resectable; neoadjuvant therapy; pancreatic cancer.

Figure 1

Borderline Resectable Pancreatic Cancer Imaging. Examples of borderline resectable pancreatic adenocarcinoma. (A) Axial view of pancreatic tumor narrowing the superior mesenteric vein (SMV) indicated by the yellow arrow; (B) The same pancreatic mass narrowing the SMV on coronal view; (C) Abutment (<180 degrees) of the superior mesenteric artery (SMA) by pancreatic head tumor indicated by the red arrow; (D) Large regional lymph node (white arrow) that was later biopsy proven to be metastatic pancreatic adenocarcinoma.

Figure 2

Portal vein confluence involvement of borderline resectable PDAC at time of surgery. A pancreatic ductal adenocarcinoma tumor adhered to the portal vein. Vessel loops have been used to control the venous tributaries prior to resecting the portal vein wall with the specimen. The uncinate process has been resected off the superior mesenteric artery (SMA) in preparation for vein resection.