[Resection of locally advanced pancreatic cancer: careful selection and shared decision making]

The landscape regarding the treatment possibilities for patients with locally advanced pancreatic cancer (LAPC) has changed over the last decade. The introduction of modern multi-agent chemotherapeutic regimens (i.e., FOLFIRINOX and gemcitabine/nab-paclitaxel) has improved outcomes. A minority, but still a substantial group of patients, nowadays undergo surgical resection after induction chemotherapy, providing a chance of long-term overall survival comparable to (borderline) resectable pancreatic cancer. However, selecting appropriate candidates for surgery after induction chemotherapy remains challenging, as surgery includes substantial risks which should not outweigh the potential survival benefit. Shared decision making is crucial as patients usually overestimate the value of resection. Here, we present two patients with LAPC who underwent surgical resection, but both with various work-up strategies, leading to different outcomes. These patients highlight the importance of a multidisciplinary approach to select appropriate candidates for the best treatment option, avoiding futile surgery.