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Borderline Resectable Pancreatic Cancer

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Pancreatic Cancer

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Abstract:

It is essential to use rigorous criteria to define resectability which allows accurate pretreatment staging and the development of stage-specific therapy. Tumors of borderline resectability have emerged as a distinct subset with multidetector high quality CT imaging and these patients are at a high risk for margin positive resection. Borderline resectable tumors are defined as those with tumor abutment of ≤180°(≤50%) of the SMA or celiac axis, short segment abutment or encasement of the common hepatic artery typically at the gastroduodenal artery origin, and segmental venous occlusion with sufficient venous flow above and below the occlusion to allow an option for venous reconstruction. Patients whose tumors meet these CT criteria are candidates for preoperative systemic chemotherapy followed by chemoradiation. Patients whose imaging studies show radiographic stability or regression and an improvement in serum tumor markers (CA19–9) may proceed to pancreaticoduodenectomy and may require vascular resection and reconstruction. Prospective clinical trials with well-defined eligibility criteria are necessary to determine the best overall treatment strategy for these patients.

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  1. Department of Gastrointestinal Medical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA

    Gauri R. Varadhachary

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  1. Gauri R. Varadhachary
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Varadhachary, G.R. (2010). Borderline Resectable Pancreatic Cancer. In: Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77498-5_46

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