Essential updates 2019/2020: Multimodal treatment of localized pancreatic adenocarcinoma: Current topics and updates in survival outcomes and prognostic factors

Abstract

Overall survival of patients with localized pancreatic ductal adenocarcinoma (PDAC) is extremely poor. Therefore, the establishment of multimodal treatment strategies is indispensable for PDAC patients because surgical treatment alone could not contribute to the improvement of survival. In this review article, we focus on the current topics and advancement of the treatments for localized PDAC including resectable, borderline resectable, and locally advanced PDAC in accordance with the articles mainly published from 2019 to 2020. Reviewing the articles, the recent progress of multimodal treatments notably improves the prognosis of patients with localized PDAC. For resectable PDAC, neoadjuvant chemo or chemoradiation therapy, rather than upfront surgery, plays a key role, especially in patients with a large tumor, poor performance status, high tumor marker levels, peripancreatic lymph nodes metastasis, or neural invasion suspected on preoperative imaging. For borderline resectable PDAC, neoadjuvant treatments followed by surgery is a desirable approach, and maintenance of immunonutritional status during the treatments are also important. For locally advanced disease, conversion surgery has a central role in improving a survival outcome; however, its indication should be standardized.

Keywords: conversion surgery; localized pancreatic adenocarcinoma; neoadjuvant treatment.

FIGURE 1

Typical preoperative CT images of resectable PDAC with high‐risk futures. A, The 34‐mm large tumor located in the pancreatic head (white arrows). B, The 20‐mm tumor located in the uncinate process with suspected invasion into the SMA neural plexus (white arrow heads). C, 18‐mm tumor located in pancreatic head with peripancreatic lymnodes swollen. D, The 40‐mm pancreatic tail tumor with peripheral splenic artery and gastric invasion (white arrow)