ConsensusBorderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS)
Section snippets
Methods
A computerized search of the PubMed and Embase databases was done in February 2013, using the following terms: “pancreatic cancer,” “borderline resectable,” “extended resection,” “superior mesenteric vein,” “portal vein,” “celiac axis,” “superior mesenteric artery,” “common hepatic artery,” “irresectability,” “morbidity,” “mortality,” and “survival.” All levels of evidence were included and rated, according to the evidence level of individual studies defined by the recommendations of the Centre
Which patients have borderline resectable disease?
Several study groups have proposed a preoperative classification to identify patients with BRPC. Their goal was to optimize perioperative treatment and to minimize the risk of falsely categorizing a tumor as locally advanced.
The ISGPS suggests that preoperative evaluation of resectability be based on computed tomography (CT). The use of a pancreatic protocol is mandatory to assess clinical resectability. Such a protocol should achieve an optimal balance between visualization/resolution of
Summary
Current evidence supports portomesenteric resection in patients with BRPC. There is no good evidence that arterial resections during right-sided, proximal pancreatic resections are of benefit and should not be recommended. Basic definitions were suggested and are needed for obtaining further evidence and improvements in this important subgroup of patients with vessel involvement. A consensus for each topic is given that is supported by all members of the ISGPS. Multimodal therapy comprising
References (74)
- et al.
GRADE guidelines: 14. going from evidence to recommendations: the significance and presentation of recommendations
J Clin Epidemiol
(2013) - et al.
Staging of pancreatic adenocarcinoma by imaging studies
Clin Gastroenterol Hepatol
(2008) - et al.
Results of vascular resections during pancreatectomy from two European centres: an analysis of survival and disease-free survival explicative factors
HPB (Oxford)
(2006) - et al.
Survival benefits of portal vein resection for pancreatic cancer
Am J Surg
(2003) - et al.
Vein involvement during pancreaticoduodenectomy: is there a need for redefinition of "borderline resectable disease?
J Gastrointest Surg
(2013) - et al.
Vascular resection in pancreatic cancer surgery: survival determinants
J Gastrointest Surg
(2009) - et al.
Surgical strategy for patients with pancreatic body/tail carcinoma: who should undergo distal pancreatectomy with en-bloc celiac axis resection?
Surgery
(2013) - et al.
Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas
J Gastrointest Surg
(2001) - et al.
A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer
J Gastrointest Surg
(2011) - et al.
Understanding metastasis in pancreatic cancer: a call for new clinical approaches
Cell
(2012)
EMT and dissemination precede pancreatic tumor formation
Cell
Redefining resection margin status in pancreatic cancer
HPB (Oxford)
Effect of hospital volume on margin status after pancreaticoduodenectomy for cancer
J Am Coll Surg
Impact of margin status on survival following pancreatoduodenectomy for cancer: the Leeds Pathology Protocol (LEEPP)
HPB (Oxford)
The prognostic influence of resection margin clearance following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma
J Gastrointest Surg
Borderline resectable pancreatic cancer: the importance of this emerging stage of disease
J Am Coll Surg
The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer
Cancer Treatment Rev
VEGFR-2, CXCR-2 and PAR-1 germline polymorphisms as predictors of survival in pancreatic carcinoma
Ann Oncol
The European health report 2012: charting the way to well-being
Radical pancreatoduodenectomy and portal vein resection. Report of two successful cases with transplantation of portal vein
Arch Surg
Regional resection of cancer of the pancreas: a new surgical approach
Surgery
Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures
Radiology
Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT
Radiology
Current staging systems for pancreatic cancer
Cancer J
Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy
Ann Surg Oncol
Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement
Ann Surg Oncol
Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement
Ann Surg Oncol
Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement
Ann Surg Oncol
Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer
Br J Surg
Pancreaticoduodenectomy with vascular resection: margin status and survival duration
J Gastrointest Surg
Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group
Ann Surg
Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection?
Ann Surg
Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis
World J Surg
En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients
Ann Surg
Cited by (698)
Portal vein resection in pancreatic neuroendocrine neoplasms
2024, Surgery (United States)Stereotactic body radiotherapy for pancreatic cancer – A systematic review of prospective data
2024, Clinical and Translational Radiation OncologyEndoscopic Diagnosis of Extra-Luminal Cancers
2024, Gastrointestinal Endoscopy Clinics of North America
M.B. and F.G.U. contributed equally to this work.