Behind The Knife: The Surgery Podcast Clinical Challenges in Surgical Oncology: Surgical Management for Borderline Resectable/Locally Advanced Pancreatic Cancer
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May 16, 2022 Caitlin Hester, MD, a Complex General Surgical Oncology Fellow at MD Anderson, dives into the complexities of managing borderline resectable pancreatic cancer. She explains the definitions of resectability and the role of neoadjuvant therapy in optimizing patient outcomes. Insightful discussions cover key clinical trials, imaging biomarkers, and the surgical implications of vascular involvement. Hester also highlights future directions in research, including ctDNA and potential vaccines, fostering hope for better treatment strategies in this challenging field.
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Borderline Resectability Is Multifaceted
- Borderline resectability is defined anatomically, biologically, and conditionally depending on vessel involvement and patient factors.
- MD Anderson classifies borderline cases by venous/arterial involvement, CA19-9 elevation, and poor performance status.
Neoadjuvant Therapy Tests Tumor Biology
- Pancreatic cancer behaves systemically, so neoadjuvant therapy treats occult micrometastatic disease.
- Neoadjuvant therapy aims to ensure surgery provides long-term benefit rather than only local control.
Optimize Patients With Neoadjuvant Therapy
- Use neoadjuvant therapy to optimize patients for surgery and allow prehabilitation rather than weaken them.
- Plan systemic therapy first so patients receive treatment they might miss after a difficult postoperative course.