Cancers · 4 authors, 1 centre
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This narrative review discusses surgical considerations for neoadjuvant therapy in pancreatic ductal adenocarcinoma, including resectability assessment, vascular resection and reconstruction, and patient prehabilitation. The central conclusion is that neoadjuvant therapy enhances patient selection for surgery, provides time for prehabilitation, and ensures systemic therapy delivery for PDAC.
This narrative review synthesizes evidence on surgical considerations for neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), which has a 5-year survival rate of only 11%. The authors discuss accurate determination of resectability at diagnosis based on anatomic, biologic, and clinical criteria, emphasizing borderline resectable or locally advanced PDAC is best treated with neoadjuvant therapy followed by resection. Data from multiple studies and a 2012 meta-analysis demonstrated no differences in 30-day mortality, perioperative morbidity, or 5-year overall survival between patients undergoing pancreaticoduodenectomy with venous resection versus without, with long-term patency rates greater than 80%. The review also addresses prehabilitation programs, nutritional support, and response assessment tools including CA 19-9 levels and imaging.
