How A Patient with Resectable or Borderline Resectable Pancreatic Cancer should Be Treated—A Comprehensive Review

SIMPLE SUMMARY: Recently observed improvement in the treatment of pancreatic ductal adenocarcinoma (PDAC) has resulted mainly from improved perioperative care and more effective chemotherapy. Over the past decade, there has been a gradual increase in the number of treatment options for pancreatic conditions. The PRODIGE 24 trial established mFOLFIRINOX as the standard of care in adjuvant therapy, demonstrating a significant benefit in terms of overall survival. Questions remain as to how to optimize neoadjuvant chemotherapy and who would benefit from upfront surgery instead of neoadjuvant chemotherapy. In addition, the role of chemoradiotherapy is not clearly established. The article presents our treatment plan for early pancreatic cancer supported by current research results. ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease with high morbidity and mortality in which long-term survival rates remain disastrous. Surgical resection is the only potentially curable treatment for early pancreatic cancer; however, the right patient qualification is crucial for optimizing treatment outcomes. With the rapid development of radiographic and surgical techniques, resectability decisions are made by a multidisciplinary team. Upfront surgery (Up-S) can improve the survival of patients with potentially resectable disease with the support of adjuvant therapy (AT). However, early recurrences are quite common due to the often-undetectable micrometastases occurring before surgery. Adopted by international consensus in 2017, the standardization of the definitions of resectable PDAC (R-PDAC) and borderline resectable PDAC (BR-PDAC) disease was necessary to enable accurate interpretation of study results and define which patients could benefit from neoadjuvant therapy (NAT). NAT is expected to improve the resection rate with a negative margin to provide significant local control and eliminate micrometastases to prolong survival. Providing information about optimal sequential multimodal NAT seems to be key for future studies. This article presents a multidisciplinary concept for the therapeutic management of patients with R-PDAC and BR-PDAC based on current knowledge and our own experience.