Related Experiment Videos
When to Operate After Neoadjuvant Therapy for Borderline Resectable Pancreatic Cancer: A Critical Review and
WaiSan Ho1, WenChao Xu1, JianLu Zhang1
1Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China; Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China; National Infrastructures for Translational Medicine, Peking Union Medical College Hospital, Beijing, 100730, China; State Key Laboratory of Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Background:
Surgical timing after neoadjuvant therapy for borderline resectable pancreatic cancer remains difficult because post-treatment imaging may not reliably distinguish residual tumor from fibrosis, whereas tumor biology and patient fitness strongly influence surgical benefit.
Methods:
We performed a critical narrative review of studies and guidelines addressing surgical timing, radiological response, tumor-marker dynamics, pathological response, and physiological readiness after neoadjuvant therapy for borderline resectable pancreatic cancer.
Results:
Current evidence supports a multidimensional approach rather than reliance on anatomical imaging alone. Informative tumor-marker trajectories, especially carbohydrate antigen 19-9 when reliable and alternative markers such as Duke pancreatic monoclonal antigen type 2 when carbohydrate antigen 19-9 is non-informative, are central to assessing systemic disease control. Selective use of liver magnetic resonance imaging, diffusion-weighted magnetic resonance imaging, and positron emission tomography-based modalities may help clarify discordant scenarios or detect occult metastatic disease. Patient fitness, including performance status, nutritional reserve, organ function, and recovery from treatment-related toxicity, remains essential before exploration.
Conclusion:
Surgical timing after neoadjuvant therapy for borderline resectable pancreatic cancer should integrate biology, anatomy, and patient condition. A biology-first multidisciplinary framework may help avoid futile pancreatectomy while preserving timely surgical opportunities for appropriate candidates.