Surgical Considerations for Neoadjuvant Therapy for Pancreatic Adenocarcinoma

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a challenging disease process with a 5-year survival rate of only 11%. Neoadjuvant therapy in patients with localized pancreatic cancer has multiple theoretical benefits, including improved patient selection for surgery, early delivery of systemic therapy, and assessment of response to therapy. Herein, we review key surgical considerations when selecting patients for neoadjuvant therapy and curative-intent resection. Accurate determination of resectability at diagnosis is critical and should be based on not only anatomic criteria but also biologic and clinical criteria to determine optimal treatment sequencing. Borderline resectable or locally advanced pancreatic cancer is best treated with neoadjuvant therapy and resection, including vascular resection and reconstruction when appropriate. Lastly, providing nutritional, prehabilitation, and supportive care interventions to improve patient fitness prior to surgical intervention and adequately address the adverse effects of therapy is critical.

Combination of mutations in genes controlling DNA repair and high mutational load plays a prognostic role in pancreatic ductal adenocarcinoma (PDAC): a retrospective real-life study in Sardinian population

“…In our series, 63 consecutively collected patients with potentially resectable/border line resectable PDAC (stage IIB-III; N = 55) or stage IV disease (N = 8) and tumor tissue availability were identi ed. Criteria to classify potentially resectable and border line resectable PDAC were as summarized in Jain et al 2023 [29]. Among them, eight patients were excluded because of the very low quality of the DNA extracted, and thus, the remaining 55 were included into the study and addressed to molecular screening.…”

Imaging of pancreatic ductal adenocarcinoma – An update for all stages of patient management

“…Other staging classifications have been developed, including additional prognostic factors in the decision-making process. The MD Anderson Cancer Center developed a well-known classification incorporating anatomic criteria, tumor biology and patient performance status for patient categorization [101] , [102] . This type of classification has been used later in a consensus meeting to categorize borderline resectable and locally advanced patients in different types, according to anatomic, biological, and conditional factors [103] .…”