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Contemporary management of borderline resectable pancreatic ductal adenocarcinoma
Ann Hepatobiliary Pancreat Surg 2019 May;23(2):97-108
Published online May 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.2.97
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Kyriaki Lekka1, Evanthia Tzitzi1, Alexander Giakoustidis2, Vassilios Papadopoulos1, Dimitrios Giakoustidis1

1First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece, 2Department of HPB Surgery, The Royal London Hospital, London, UK
Received August 6, 2018; Revised January 3, 2019; Accepted January 20, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive tumors, with a low rate of survival, likely due to the tendency of the tumor for early local and distant spread. Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths. Surgical resection still represents the best curative treatment for PDAC, although only 10-20% of patients are upfront resectable at diagnosis, 50% has metastatic disease and 35% locally advanced cancer. The 5-year overall survival (OS) after curative resection is limited to 20%. Moreover among patients who undergo surgery, 30% develop early recurrence while most of them will eventually relapse. The risk of early failure after surgery could be associated with inadequate preoperative radiological staging, lack of radical surgery and differences in tumor aggressiveness. In recent years, more accurate patient categorization due to sophisticated imaging tools and techniques increase the survival rate while neoadjuvant treatment can help surgeons select patients who will benefit most from surgery. Neoadjuvant therapy includes chemotherapy alone, chemoradiotherapy, chemotherapy with chemoradiation and targeted therapies. The aim of this review is to present the available data concerning the management of patients with borderline PDAC.
Keywords : Pancreatic adenocarcinoma; Borderline resectable; Chemotherapy; Chemoradiation