Motivation in efforts to increase surgical candidates is consequent to complete tumor resection being the sole option for cure. Close collaborative efforts between surgeons, oncologists, radiation oncologists, and diagnostic imaging has resulted in the development of resectable and borderline resectable disease criteria over the last decade. Increasingly sophisticated surgical techniques, including complex vascular reconstruction and use of neoadjuvant and adjuvant therapies have increased demand of more detailed and specific radiological interpretation of disease extent. Surgical definition of borderline resectable pancreatic cancer is based on five important observations: 1) long-term survival necessitates complete resection of the primary tumor and regional lymph nodes; 2) negative resection margins are less likely with increasing tumor involvement of the SMV-PV and SMA; 3) SMV-PV and hepatic artery resection (not SMA) at pancreatectomy has been associated with acceptable outcomes; 4) administration of conventional cytotoxic agents rarely results in down-staging locally advanced pancreatic cancer; and 5) tumor response to neoadjuvant chemotherapy and chemoradiation may be indicative of favorable tumor physiology and biology, and thus used to select patients who may benefit from aggressive surgery [17-25].
Staging of Pancreatic Ductal Adenocarcinoma. Motivation in efforts to increase surgical candidates is consequent to complete tumor resection being the sole option for cure. Close collaborative efforts between surgeons, oncologists, radiation oncologists, and diagnostic imaging has resulted in the development of resectable and borderline resectable disease criteria over the last decade. Increasingly sophisticated surgical techniques, including complex vascular reconstruction and use of neoadjuvant and adjuvant therapies have increased demand of more detailed and specific radiological interpretation of disease extent. Surgical definition of borderline resectable pancreatic cancer is based on five important observations: 1) long-term survival necessitates complete resection of the primary tumor and regional lymph nodes; 2) negative resection margins are less likely with increasing tumor involvement of the SMV-PV and SMA; 3) SMV-PV and hepatic artery resection (not SMA) at pancreatectomy has been associated with acceptable outcomes; 4) administration of conventional cytotoxic agents rarely results in down-staging locally advanced pancreatic cancer; and 5) tumor response to neoadjuvant chemotherapy and chemoradiation may be indicative of favorable tumor physiology and biology, and thus used to select patients who may benefit from aggressive surgery [17-25].