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Cholangiocarcinoma and Gallbladder Cancer Studies / Renal Cell Carcinoma Treatment · Journal article
Frontiers in Surgery · September 8, 2026
A consensus or society position rather than new primary data.
This structured narrative review synthesizes contemporary evidence on neoadjuvant therapy and surgery for borderline resectable pancreatic ductal adenocarcinoma, proposing that treatment decisions should integrate vascular anatomy with biological response and clinical status rather than anatomy alone. The authors recommend standardized restaging protocols, selective patient selection for resection based on treatment response, and concentration of vascular procedures in high-volume centers, but provide guidance rather than new original evidence.
Structured narrative review of randomized and prospective studies, high-quality observational cohorts, and international guidelines. Published evidence on borderline resectable pancreatic ductal adenocarcinoma management; international clinical guidelines. Intervention: Neoadjuvant therapy followed by surgical resection, with decision-making informed by post-NAT restaging (CT, CA19-9, FDG-PET, DWI-MRI, radiomics, biomarkers) and intraoperative vascular tactics.
Neoadjuvant therapy is now preferred initially, with resection reserved for carefully selected responders Contrast-enhanced CT and CA19-9 kinetics are mainstays of post-NAT restaging, while FDG-PET, DWI-MRI, radiomics, and biomarkers serve as problem-solving adjuncts when findings are equivocal Venous resection is standard during surgery, arterial resection is selective, and periarterial divestment spares the artery in some cases
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and multidisciplinary teams managing BRPC should integrate response to neoadjuvant therapy and biological markers into surgical selection decisions, rather than relying on anatomic criteria alone. Complex vascular resection should be concentrated in high-volume experienced centers, and standardized restaging and anticoagulation protocols require further development.
This is a structured narrative review synthesizing evidence and international guidelines on surgical management of borderline resectable pancreatic cancer in the neoadjuvant therapy era, offering a practical decision-making framework rather than reporting original trial data.
As stated by the source record.
Clinicians and multidisciplinary teams managing BRPC should integrate response to neoadjuvant therapy and biological markers into surgical selection decisions, rather than relying on anatomic criteria alone. Complex vascular resection should be concentrated in high-volume experienced centers, and standardized restaging and anticoagulation protocols require further development.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Background Neoadjuvant therapy (NAT) has become central to the management of borderline resectable pancreatic ductal adenocarcinoma (BRPC). This surgical narrative review offers a contemporary synthesis of evidence and guidelines, with emphasis on pretreatment staging, post-NAT surgical selection, intraoperative vascular tactics, and postoperative care. Methods We conducted a structured narrative review of randomized and prospective studies, high-quality observational cohorts, and major international guidelines published through 31 December 2025. A systematic search of PubMed was performed, and key data were synthesized to inform a practical decision-making framework. Results Although BRPC remains defined largely by vascular anatomy, biological and conditional factors are increasingly incorporated into decision-making. NAT is preferred initially, with resection reserved for carefully selected responders. For post-NAT restaging, contrast-enhanced CT and CA19-9 kinetics are the mainstays, while FDG-PET, DWI-MRI, radiomics, and biomarkers serve as problem-solving adjuncts when findings are equivocal. Surgical exploration is guided by physiologic recovery, absence of metastatic progression, and multidisciplinary consensus. Staging laparoscopy remains useful for detecting occult metastases. Intraoperative vascular resection is margin-driven, not routine: venous resection is standard, arterial resection is selective, and periarterial divestment spares the artery in some cases. Short-term surgical morbidity does not appear to be increased by NAT, yet the absence of uniform protocols for post-reconstruction anticoagulation represents an important area for future investigation. Conclusions NAT has fundamentally transformed the management of BRPC, establishing a surgical pathway that is dictated by tumor biology and sequentially timed according to treatment response and clinical course. Optimizing outcomes ultimately depends on standardized restaging protocols, judicious selection of patients who truly benefit from resection, and the concentration of complex vascular procedures in high-volume, experienced centers. A practical algorithm is proposed to synthesize these decision points for clinical use.
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