Surgical therapy strategies of borderline resectable pancreatic cancer

The "borderline resectable" pancreatic cancer is a distinct subset which blurs the distinction between resectable and locally advanced disease.Patients with borderline resectable pancreatic cancer include those whose tumors have invaded either superior mesenteric vein, portal vein, common hepatic artery or superior mesenteric artery, but are still amenable to resection and reconstruction.The issues of surgical treatment for borderline resectable pancreatic cancer are as follows: the safety and efficacy of vascular resection and reconstruction, the boundary of extended lymphadenectomy, and the standardized examination of resection margin.A preoperative chemotherapy is recommended for these patients to maximize the potential for an R0 resection, despite the fact there is still no standard chemotherapy regimen or RCT research evidences.Under the current concept of multidisciplinary treatment for this disease, the clinical value of an R1 resection for the borderline resectable pancreatic cancer should be reconsidered.