J.Jpn. Surg. Soc.. 122(2): 179-184, 2021

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POSSIBLE REVISION OF DEFINITION IN NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES

The American Joint Committee on Cancer has established a staging system for the degree of progression of pancreatic cancer. Therefore, there is little biological significance in defining the category of “borderline resectable” due to the limitations of surgical techniques based on imaging findings such as the contact angle of pancreatic tumors with blood vessels. The impact of the borderline resectable category based on initial imaging studies is weakening in the era of neoadjuvant treatment. What is currently needed in the clinical setting is a category that determines whether resection is acceptable at each phase during the preoperative treatment period. Prediction of overall survival and recurrence-free survival rates with an integrated scoring system using preoperative prognostic indices before/after neoadjuvant therapy for pancreatic ductal adenocarcinoma was feasible in our prospective study. The integrated scoring system may indicate a new definition of borderline resectable pancreatic cancer. Another issue is the poor prognosis in patients with radiographic splenic artery involvement who undergo upfront surgery for resectable pancreatic body and tail cancer. Radiographic splenic artery involvement may have a potential role in stratification of treatment strategies for patients with resectable pancreatic body/tail cancer.

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