Recent advancements in chemo/radiotherapy have rendered previously inoperable patients with pancreatic ductal adenocarcinoma (PDAC) potentially resectable. This narrative review highlights the current state of surgical treatment for borderline resectable, locally advanced, and synchronous or metachronous oligometastatic PDAC. Neoadjuvant therapy (NAT) is recommended before surgery, although the best response rate is still limited. Methods for selecting NAT responders and identifying non-responders early remain uncertain. Imaging techniques like multidetector computed tomography have some limitations, while CA 19-9 and positron emission tomography show promise. High-level evidence supporting the surgical benefit in these cases is lacking, emphasizing the need for specialized interdisciplinary teams in high-volume centers.
Review by Pedrazzoli S in J Clin Med