Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.516
Peer-review started: February 28, 2021
First decision: April 6, 2021
Revised: April 9, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: June 27, 2021
Processing time: 109 Days and 21.3 Hours
Borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) is currently a well-recognized entity, characterized by some specific anatomic, biological and conditional features: It includes patients with a stage of disease intermediate between the resectable and the locally advanced ones. The term BR identifies a tumour with an aggressive biological behaviour, on which a neoadjuvant approach instead of an upfront surgery one should be preferred, in order to obtain a radical resection (R0) and to avoid an early recurrence after surgery. Even if during the last decades several studies on this topic have been published, some aspects of BR-PDAC still represent a matter of debate. The aim of this review is to critically analyse the available literature on this topic, particularly focusing on: The problem of the heterogeneity of definition of BR-PDAC adopted, leading to a misinterpretation of published data; its current management (neoadjuvant vs upfront surgery); which neoadjuvant regimen should be preferably adopted; the problem of radiological restaging and the determination of resectability after neoadjuvant therapy; the post-operative outcomes after surgery; and the role and efficacy of adjuvant treatment for resected patients that already underwent neoadjuvant therapy.
Core Tip: The term borderline resectable identifies a tumour with an aggressive biological behaviour, on which a neoadjuvant approach instead of upfront surgery one should be preferred, in order to obtain a radical resection (R0) and to avoid an early recurrence after surgery. The aim of this review is to critically analyse the available literature on this topic.