Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1223-1230
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1223
Neoadjuvant treatment of pancreatic ductal adenocarcinoma: Whom, when and how
Nebojsa Manojlovic, Goran Savic, Stevan Manojlovic
Nebojsa Manojlovic, Clinic for Gastroenterology and Hepatology, Military Medical Academy, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade 11000, Serbia
Goran Savic, Military Medical Academy, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade 11000, Serbia
Stevan Manojlovic, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
Author contributions: Manojlovic N, Savic G, and Manojlovic S contributed to this paper; Manojlovic N designed the overall concept and outline of the manuscript, and drafted and edited the manuscript; Savic G and Manojlovic S contributed to the discussion and design of the manuscript, and made critical revision of the manuscript and contributed to the review of literature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nebojsa Manojlovic, PhD, Associate Professor, Clinic for Gastroenterology and Hepatology, Military Medical Academy, Faculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, Belgrade 11000, Serbia. nebojsa.manojlovic1@gmail.com
Received: December 28, 2023
Revised: March 13, 2024
Accepted: April 22, 2024
Published online: May 27, 2024
Processing time: 146 Days and 10.1 Hours
Core Tip

Core Tip: Pancreatic ductal adenocarcinoma, which is notorious for its aggressiveness and poor prognosis, remains an area of great unmet medical need. The most important determinant of survival is surgical resection. Nearly 60% of patients who undergo upfront surgery for resectable tumours are unable to receive adequate adjuvant chemotherapy (CHT). An important paradigm shift to achieve better outcomes has been the sequence of therapy, with neoadjuvant CHT preceding surgery. Three surgical stages have emerged for the preoperative assessment of nonmetastatic pancreatic cancers: Resectable, borderline-resectable and unresectable locally advanced tumours. In the development of new neoadjuvant and induction strategies, the distinct molecular and biological characteristics of the various pancreatic cancer subgroups need to be integrated to optimize the selection and sequencing of both established and novel treatment modalities that may improve survival outcomes.