Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS)

Borderline Resectable Pancreatic Cancer

“…Type 1-partial venous excision with direct closure; type 2-partial venous excision using a patch; type 3-segmental resection with primary veno-venous anastomosis; and type 4-segmental resection with interposed venous conduit and at least two anastomoses. Portal venous tumor invasion has been shown to be a negative prognostic factor [3], and the depth of tumor invasion is even more accurate for determining survival [26]. Deeper portal vein invasion into the tunica media or intima was an independent prognostic factor for poor survival.…”

“…The benefits of high resolution CT using a "pancreas protocol" as the imaging modality of choice is uniformly agreed upon. Such a protocol should achieve an optimal balance between visualization/resolution of normal pancreatic and malignant parenchyma as well as of liver parenchyma and arterial and venous vessel enhancement/visibility [3]. This protocol is accurate in predicting resectability in over 80 % of tumors and over 90 % successful in identifying vascular invasion.…”

“…On the contrary, Worni et al demonstrated an increase in intraoperative and postoperative morbidity but no increase in operative mortality in patients undergoing concomitant vascular resections [25]. The ISGPS strongly recommends operative exploration and resection in the presence of reconstructable mesentericoportal axis involvement while recommending against the use of neoadjuvant treatment protocols in BRPC patients with isolated venous involvement [3]. They have further proposed to classify the venous resections to help with more detailed, evidence-based future recommendations.…”

“…The ISGPS does not recommend arterial resections on a routine basis in patients with BRPC. However they suggest that patients categorized as borderline resectable due to suspicion of arterial infiltration on imaging should undergo surgical exploration given the inadequate differentiation between fibrous adhesions and true cancerous invasion [3,28,29]. Neoadjuvant treatment protocols have not shown improved tumor clearance in BRPC patients [30].…”

“…The poor outcomes associated with this disease are caused in large part by a majority of patients presenting with advanced disease at the time of initial diagnosis. Currently, at the time of diagnosis, approximately 53 % of patients have metastatic disease, while another 25 % have locally advanced disease [3]. The prognosis of patients with pancreatic cancer is dismal, as the 1 and 5-year relative survival rates are 27 and 6 %, respectively [2].…”