Management of Borderline Resectable Pancreatic Cancer

ArticleinSurgical Oncology Clinics of North America 19(2):359-70 · April 2010with5 Reads
DOI: 10.1016/j.soc.2009.11.006 · Source: PubMed
Abstract
Borderline resectable pancreatic cancer is an emerging stage of disease defined by computed tomogrpahy criteria, patient (Katz type B), or disease characteristics (Katz type C). These patients are particularly well suited to a surgery-last strategy with induction therapy consisting of chemotherapy (gemcitabine alone or in combination) followed by chemoradiation. With appropriate selection and preoperative planning, many patients with borderline resectable disease derive clinical benefit from multimodality therapy. The use of a standardized system for the staging of localized pancreatic cancer avoids indecision and allows for the optimal treatment of all patients guided by the extent of their disease. In this article, 2 case reports are presented, and the term borderline resectable pancreatic cancer is discussed. The advantages of neoadjuvant therapy and surgery are also discussed.
    • "CT should be performed using a so-called, pancreas protocol: tri-phasic contrast (non-contrast, arterial, pancreatic parenchymal, portal venous) in thin cross sectional cuts (≤ 3 mm) with multiplanar reconstructions. While CT performed in this manner has an excellent negative predictive value for unresectability, it is not as accurate at predicting re- sectability [35] . This is, at least in part, due to its lack of sensitivity for identifying small hepatic and peritoneal metastases. "
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