Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2021; 13(6): 516-528
Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.516
Borderline resectable pancreatic cancer: Certainties and controversies
Gennaro Nappo, Greta Donisi, Alessandro Zerbi
Gennaro Nappo, Greta Donisi, Alessandro Zerbi, Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano 20089, Italy
Author contributions: Nappo G and Zerbi A contributed to the conception and design of the study; Nappo G, Donisi G and Zerbi A drafted and critically revised the manuscript and approved the final version of the article; Nappo G and Zerbi A are directly responsibility for the manuscript.
Conflict-of-interest statement: None of the authors have conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gennaro Nappo, MD, Surgeon, Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano 20089, Italy. gennaro.nappo@humanitas.it
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: April 6, 2021
Revised: April 9, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: June 27, 2021
Processing time: 109 Days and 21.3 Hours
Abstract

Borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) is currently a well-recognized entity, characterized by some specific anatomic, biological and conditional features: It includes patients with a stage of disease intermediate between the resectable and the locally advanced ones. The term BR identifies a tumour with an aggressive biological behaviour, on which a neoadjuvant approach instead of an upfront surgery one should be preferred, in order to obtain a radical resection (R0) and to avoid an early recurrence after surgery. Even if during the last decades several studies on this topic have been published, some aspects of BR-PDAC still represent a matter of debate. The aim of this review is to critically analyse the available literature on this topic, particularly focusing on: The problem of the heterogeneity of definition of BR-PDAC adopted, leading to a misinterpretation of published data; its current management (neoadjuvant vs upfront surgery); which neoadjuvant regimen should be preferably adopted; the problem of radiological restaging and the determination of resectability after neoadjuvant therapy; the post-operative outcomes after surgery; and the role and efficacy of adjuvant treatment for resected patients that already underwent neoadjuvant therapy.

Keywords: Borderline resectable pancreatic cancer; Pancreatic cancer; Neoadjuvant treatment; Chemotherapy; Radiotherapy; Pancreatic tumour

Core Tip: The term borderline resectable identifies a tumour with an aggressive biological behaviour, on which a neoadjuvant approach instead of upfront surgery one should be preferred, in order to obtain a radical resection (R0) and to avoid an early recurrence after surgery. The aim of this review is to critically analyse the available literature on this topic.