2021 TDDW
Symposium (II) HOW TO EXPAND AND OPTIMIZE SURGICAL CRITERIA OF LOCALLY ADVANCED PANCREATIC CANCER
DEFINITION OF BORDERLINE – RESECTABLE PANCREATIC CANCER Chien-Hui Wu Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan Surgical Oncologist, Pancreatic Cancer Precision Medicine Center of Excellence, National Taiwan University Hospital, Taipei, Taiwan After the concept of borderline resectable pancreatic cancer was established by the National Comprehensive Cancer Network in 2006, several definitions of borderline resectable pancreatic cancer were given by different organizations, such as the MD Anderson Cancer Center (MDACC), Alliance trial, Americas Hepato-Pancreato-Biliary Association (AHPBA), Society for Surgery of the Alimentary (SSAT) and Society of Surgical Oncology (SSO). In clinical practice, the initial treatment decision may be highly dependent on the quality of preoperative imaging and the surgeon’s surgical experience, as the definition of resectability is based on anatomical criteria. Since the improvements in surgical techniques, chemotherapy, and radiotherapy, more research has focused not only on anatomical aspects but also on technical or biological aspects. Technically, borderline resectable pancreatic cancer is highly dependent on the ability to resect/reconstruct arteries and veins. In contrast to the celiac and superior mesenteric arteries,
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the portal vein and common hepatic artery are considered to be reconstructable. Recently, borderline resectability of pancreatic cancer was redefined through international consensus criteria based on anatomical, biological (elevated serum carbohydrate antigen 19-9), and conditional (Eastern Cooperative Oncology Group performance) dimensions. In the era of precision medicine, the definition of borderline resectable pancreatic cancer goes beyond the anatomic relationship between the tumor and vessels. Neoadjuvant chemotherapy and surgery are associated with improved outcomes. Due to the molecular diversity of borderline resectable pancreatic cancer and its impact on prognosis and treatment response, a paradigm shift to a genome-driven approach is required. This is particularly important in preoperative, potentially curative cases, where a more individualized approach is used to guide individualized treatment.
