Surgery for borderline resectable pancreatic cancer: The Japanese experience

We evaluated the outcomes of patients who initially presented with borderline resectable or locally unresectable pancreatic ductal adenocarcinoma (PDAC) using data obtained both from a multi-institutional survey administered in Japan and from our institution. We paid special attention to the role of CRT before surgery and innovations in surgical technique. Borderline resectable PDAC includes two distinct categories of tumors: BR-PV (tumors which invade the PV/SMV alone) and BR-A (tumors which invade major arteries). The prognosis associated with these two categories of tumors differs significantly. Preoperative chemoradiation protocols may improve the survival of patients with borderline resectable PDAC-particularly of patients with BR-A tumors-by enhancing the R0 resection rate. "Adjuvant surgery" for patients who initially present with unresectable cancers but who have a long-term response to nonsurgical therapies has proven to be effective. The administration of chemoradiation to patients with locally advanced cancer may allow for the identification of candidates for aggressive "adjuvant surgery" and to improve the prognosis of patients who receive an R0 resection.