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Review
. 2023 Apr 30;15(9):2584.
doi: 10.3390/cancers15092584.

Current Approaches for the Curative-Intent Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Maciej Słodkowski  1   2 , Marek Wroński  1 , Dominika Karkocha  1 , Leszek Kraj  2   3 , Kaja Śmigielska  1 , Aneta Jachnis  1
Affiliations
Review

Current Approaches for the Curative-Intent Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Maciej Słodkowski et al. Cancers (Basel). .

Abstract

Radical resection is the only curative treatment for pancreatic cancer. However, only up to 20% of patients are considered eligible for surgical resection at the time of diagnosis. Although upfront surgery followed by adjuvant chemotherapy has become the gold standard of treatment for resectable pancreatic cancer there are numerous ongoing trials aiming to compare the clinical outcomes of various surgical strategies (e.g., upfront surgery or neoadjuvant treatment with subsequent resection). Neoadjuvant treatment followed by surgery is considered the best approach in borderline resectable pancreatic tumors. Individuals with locally advanced disease are now candidates for palliative chemo- or chemoradiotherapy; however, some patients may become eligible for resection during the course of such treatment. When metastases are found, the cancer is qualified as unresectable. It is possible to perform radical pancreatic resection with metastasectomy in selected cases of oligometastatic disease. The role of multi-visceral resection, which involves reconstruction of major mesenteric veins, is well known. Nonetheless, there are some controversies in terms of arterial resection and reconstruction. Researchers are also trying to introduce personalized treatments. The careful, preliminary selection of patients eligible for surgery and other therapies should be based on tumor biology, among other factors. Such selection may play a key role in improving survival rates in patients with pancreatic cancer.

Keywords: adjuvant treatment; pancreatic cancer; radical resection; resectability.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Definition of patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C), proposed by the international consensus on definition and criteria of borderline resectable PDAC (2017) [15]. Abbreviations: SMV, superior mesenteric vein; PV, portal vein; SMA, superior mesenteric artery; CA, celiac artery; CHA, common hepatic artery; PHA, proper hepatic artery.
Figure 2
Figure 2
Radical resection with vascular clearance. Abbreviations: SMV, superior mesenteric vein; PV, portal vein; SMA, superior mesenteric artery; CA, celiac artery; CHA, common hepatic artery; PHA, proper hepatic artery; P, pancreas.
Figure 2
Figure 2
Radical resection with vascular clearance. Abbreviations: SMV, superior mesenteric vein; PV, portal vein; SMA, superior mesenteric artery; CA, celiac artery; CHA, common hepatic artery; PHA, proper hepatic artery; P, pancreas.
Figure 3
Figure 3
Flow chart of pre- and intraoperative decision making (green color; resectable tumour, yellow; borderline resectable or locally advanced with radical resection after oncological therapy, red; metastatic).
See this image and copyright information in PMC

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