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World J Gastroenterol. Aug 28, 2014; 20(32): 11210-11215
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11210
Selection criteria in resectable pancreatic cancer: A biological and morphological approach
Domenico Tamburrino, Stefano Partelli, Stefano Crippa, Alberto Manzoni, Angela Maurizi, Massimo Falconi
Domenico Tamburrino, Stefano Partelli, Stefano Crippa, Alberto Manzoni, Angela Maurizi, Massimo Falconi, Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, 60126 Ancona-Torrette, Italy
Author contributions: Crippa S, Manzoni A and Maurizi A performed the review of the literature; Tamburrino D and Partelli S wrote the paper under the supervision of Falconi M.
Correspondence to: Massimo Falconi, MD, Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Via Conca 71, 60126 Ancona-Torrette, Italy. m.falconi@univpm.it
Telephone: +39-71-5965781 Fax: +39-71-5964429
Received: November 5, 2013
Revised: February 13, 2014
Accepted: April 15, 2014
Published online: August 28, 2014
Processing time: 297 Days and 5.7 Hours
Abstract

Pancreatic ductal adenocarcinoma (PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.

Keywords: Pancreatic ductal adenocarcinoma; Pancreatic cancer; Borderline resectable pancreatic cancer; Pancreatic surgery; Pancreatic cancer staging

Core tip: The aim of this work was to improve identification of patients with pancreatic ductal adenocarcinoma, who will benefit from pancreatic resection. Duration of symptoms and level of carbohydrate antigen 19.9 in patients with resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer.