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Practice Guideline
. 2024 Sep;76(5):1573-1591.
doi: 10.1007/s13304-024-01860-0. Epub 2024 Apr 29.

REDISCOVER guidelines for borderline-resectable and locally advanced pancreatic cancer: management algorithm, unanswered questions, and future perspectives

Ugo Boggi  1 , Emanuele F Kauffmann  2 , Niccolò Napoli  2 , S George Barreto  3   4 , Marc G Besselink  5   6 , Giuseppe K Fusai  7 , Thilo Hackert  8 , Mohammad Abu Hilal  9 , Giovanni Marchegiani  10 , Roberto Salvia  11 , Shailesh V Shrikhande  12 , Mark Truty  13 , Jens Werner  14 , Christopher Wolfgang  15 , Elisa Bannone  9 , Giovanni Capretti  16 , Alice Cattelani  11 , Alessandro Coppola  17 , Alessandro Cucchetti  18 , Davide De Sio  19 , Armando Di Dato  2 , Giovanna Di Meo  20 , Claudio Fiorillo  19 , Cesare Gianfaldoni  2 , Michael Ginesini  2 , Camila Hidalgo Salinas  21 , Quirino Lai  22 , Mario Miccoli  23 , Roberto Montorsi  5   6 , Michele Pagnanelli  16 , Andrea Poli  23 , Claudio Ricci  24 , Francesco Sucameli  9 , Domenico Tamburrino  25 , Virginia Viti  2 , John Cameron  26 , Pierre-Alain Clavien  27 , Horacio J Asbun  28 ; REDISCOVER guidelines group
Collaborators, Affiliations
Practice Guideline

REDISCOVER guidelines for borderline-resectable and locally advanced pancreatic cancer: management algorithm, unanswered questions, and future perspectives

Ugo Boggi et al. Updates Surg. 2024 Sep.

Abstract

The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC to align with modern treatment strategies and to solve some contradictions within the current definition, such as grouping "difficult" and "impossible" to resect tumors together. Furthermore, the REDISCOVER guidelines highlight several areas requiring urgent research. These include the resection of the superior mesenteric artery, the management strategies for patients with LA-PDAC who are fit for surgery but unable to receive multi-agent neoadjuvant chemotherapy, the approach to patients with LA-PDAC who are fit for surgery but demonstrate high serum Ca 19.9 levels even after neoadjuvant treatment, and the optimal timing and number of chemotherapy cycles prior to surgery. Additionally, the role of primary chemoradiotherapy versus chemotherapy alone in LA-PDAC, the timing of surgical resection post-neoadjuvant/primary chemoradiotherapy, the efficacy of ablation therapies, and the management of oligometastasis in patients with LA-PDAC warrant investigation. Given the limited evidence for many issues, refining existing management strategies is imperative. The establishment of the REDISCOVER registry ( https://rediscover.unipi.it/ ) offers promise of a unified research platform to advance understanding and improve the management of BR-PDAC and LA-PDAC.

Keywords: Borderline resectable pancreatic cancer; Locally advanced pancreatic cancer; Pancreatic cancer; Pancreatic ductal adenocarcinoma; REDISCOVER guidelines; REDISCOVER registry.

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Conflict of interest statement

S. George Barreto has the following conflicts of interest to disclose: support from Flinders Foundation grant: 49358025, NHMRC Ideas Grant: 2021009, Pankind 21.R7.INV.CB.UOSA.6.2. All the other authors have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of systematic literature review (reproduced from Ann Surg. 2024 Feb 26. 10.1097/SLA.0000000000006248)
Fig. 2
Fig. 2
Flowchart of the guideline process (reproduced from Ann Surg. 2024 Feb 26. 10.1097/SLA.0000000000006248)
Fig. 3
Fig. 3
Management algorithm for patients with BR-PDAC and LA-PDAC based on the REDISCOVER guidelines
See this image and copyright information in PMC

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