TY - JOUR
T1 - Borderline resectable pancreatic cancer
T2 - Definitions, management, and role of preoperative therapy
AU - Varadhachary, Gauri R.
AU - Tamm, Eric P.
AU - Abbruzzese, James L.
AU - Xiong, Henry Q.
AU - Crane, Christopher H.
AU - Wang, Huamin
AU - Lee, Jeffrey E.
AU - Pisters, Peter W.T.
AU - Evans, Douglas B.
AU - Wolff, Robert A.
N1 - Funding Information:
Supported by The Lockton Fund for Pancreatic Cancer Research at The University of Texas M. D. Anderson Cancer Center.
PY - 2006/8
Y1 - 2006/8
N2 - With recent advances in pancreatic imaging and surgical techniques, a distinct subset of pancreatic tumors is emerging that blurs the distinction between resectable and locally advanced disease: tumors of "borderline resectability." In our practice, patients with borderline-resectable pancreatic cancer include those whose tumors exhibit encasement of a short segment of the hepatic artery, without evidence of tumor extension to the celiac axis, that is amenable to resection and reconstruction; tumor abutment of the superior mesenteric artery involving <180° of the circumference of the artery; or short-segment occlusion of the superior mesenteric vein, portal vein, or their confluence with a suitable option available for vascular reconstruction because the veins are normal above and below the area of tumor involvement. With currently available surgical techniques, patients with borderline-resectable pancreatic head cancer are at high risk for a margin-positive resection. Therefore, our approach to these patients is to use preoperative systemic therapy and local-regional chemoradiation to maximize the potential for an R0 resection and to avoid R2 resections. In our experience, patients with favorable responses to preoperative therapy (radiographical evidence of tumor regression and improvement in serum tumor marker levels) are the subset of patients who have the best chance for an R0 resection and a favorable long-term outcome. Published by Springer Science+Business Media, Inc.
AB - With recent advances in pancreatic imaging and surgical techniques, a distinct subset of pancreatic tumors is emerging that blurs the distinction between resectable and locally advanced disease: tumors of "borderline resectability." In our practice, patients with borderline-resectable pancreatic cancer include those whose tumors exhibit encasement of a short segment of the hepatic artery, without evidence of tumor extension to the celiac axis, that is amenable to resection and reconstruction; tumor abutment of the superior mesenteric artery involving <180° of the circumference of the artery; or short-segment occlusion of the superior mesenteric vein, portal vein, or their confluence with a suitable option available for vascular reconstruction because the veins are normal above and below the area of tumor involvement. With currently available surgical techniques, patients with borderline-resectable pancreatic head cancer are at high risk for a margin-positive resection. Therefore, our approach to these patients is to use preoperative systemic therapy and local-regional chemoradiation to maximize the potential for an R0 resection and to avoid R2 resections. In our experience, patients with favorable responses to preoperative therapy (radiographical evidence of tumor regression and improvement in serum tumor marker levels) are the subset of patients who have the best chance for an R0 resection and a favorable long-term outcome. Published by Springer Science+Business Media, Inc.
KW - Borderline resectable
KW - Management
KW - Pancreatic cancer
KW - Preoperative therapy
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U2 - 10.1245/ASO.2006.08.011
DO - 10.1245/ASO.2006.08.011
M3 - Review article
C2 - 16865597
AN - SCOPUS:33748365398
SN - 1068-9265
VL - 13
SP - 1035
EP - 1046
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 8
ER -