Selection criteria in resectable pancreatic cancer: a biological and morphological approach

World J Gastroenterol. 2014 Aug 28;20(32):11210-5. doi: 10.3748/wjg.v20.i32.11210.


Pancreatic ductal adenocarcinoma (PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.

Keywords: Borderline resectable pancreatic cancer; Pancreatic cancer; Pancreatic cancer staging; Pancreatic ductal adenocarcinoma; Pancreatic surgery.

Publication types

  • Review

MeSH terms

  • Animals
  • Biomarkers / blood
  • CA-19-9 Antigen / blood
  • Carcinoma, Pancreatic Ductal / blood
  • Carcinoma, Pancreatic Ductal / diagnostic imaging
  • Carcinoma, Pancreatic Ductal / mortality
  • Carcinoma, Pancreatic Ductal / secondary
  • Carcinoma, Pancreatic Ductal / surgery*
  • Decision Support Techniques
  • Diagnostic Imaging / methods
  • Humans
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Pancreatectomy* / adverse effects
  • Pancreatectomy* / mortality
  • Pancreatic Neoplasms / blood
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Patient Selection*
  • Predictive Value of Tests
  • Radiography
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • CA-19-9 Antigen