Neoadjuvant therapy in resectable pancreatic cancer-is this the way forward?-a narrative review

Pancreatic cancer represents a systemic disease, and its treatment ideally includes the administration of systemic therapy regardless of its anatomical stage.

In this brief narrative review, the most recent literature will be highlighted, together with updates, new perspectives on the topic, and the authors own personal view.

While preoperative therapy has recently become the new standard for borderline resectable stages, adjuvant therapy after surgery remains the current standard of care for resectable disease. However, to deliver systemic therapy in the postoperative setting implies that a significant subset of patients, not fully recovering after a pancreatectomy, will never receive appropriate treatment. Administration of chemotherapy before pancreatectomy may represent the only way to assure optimal treatment, simultaneously selecting patients for surgery according to tumor biology. For these reasons, many high-volume centers for pancreatic surgical oncology are increasingly considering this strategy also for patients with resectable disease.

Nonetheless, available data to support this paradigm shift are still germinal, and the optimal modalities and timing of preoperative therapy are eagerly debated as well.