Surgical Resection for Borderline and Locally Advanced Pancreatic Adenocarcinoma

Projected to be the second leader cause of cancer death in the United States by 2030, pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a rising incidence. With ever-improving multimodal neoadjuvant treatment strategies, and ever-expanding definitions of resectability, more patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) are undergoing curative-intent surgery than ever before. Herein, we will define BRPC and LAPC, and then review the evidence for neoadjuvant chemotherapy, chemoradiation, and surgical management strategies. Lastly, we will describe the standardized Mayo Clinic approach to PDAC that centers 3 key principles: responsivity, reconstructability, and recoverability.