Incorporating a new criteria of resectability for pancreatic ductal adenocarcinomaABSTRACT
The classification of resectability for pancreatic ductal adenocarcinoma is crucial in guiding treatment strategies. A recent system including anatomic (A), biological (B), and conditional (C) factors has been used to select the patients who underwent pancreatoduodenectomy, and centralization has been associated with low mortality and defined as a critical determinant of surgical outcomes. A comprehensive literature review assessed the impact of incorporating the ABC criteria in patients with pancreatic ductal adenocarcinoma. Incorporating biological and conditional criteria for patients with pancreatic ductal adenocarcinoma could enhance patient stratification accuracy and improve clinical outcomes and survival.
Keywords:
Pancreatic neoplasms; Pancreatectomy; Pancreaticoduodenectomy; Survival
ARTICLE HIGHLIGHTS
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The classification of resectability in pancreatic ductal adenocarcinoma has evolved from purely anatomic criteria to include biological and conditional factors, improving patient selection for surgery
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The ABC (Anatomic, Biological, Conditional) system proposed by the International Association of Pancreatology refines preoperative assessment and guides the decision between initial resection or neoadjuvant therapy.
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Elevated serum CA 19–9 levels above 500 U/mL, even in anatomically resectable tumors, are associated with worse survival and may indicate the need for neoadjuvant chemotherapy.
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he MetroPancreas model, based on tumor size and CA 19–9 levels, is a useful tool for predicting the futility of pancreatectomy and supporting individualized clinical decision-making.
CENTRAL MESSAGE
Locally advanced pancreatic ductal adenocarcinoma is typically considered unresectable due to major vascular involvement. In recent years, the treatment paradigm for borderline resectable and locally advanced has shifted significantly, with neoadjuvant therapy emerging as the standard of care. This approach, often preferred over upfront surgery, aims to downstage the tumor, reduce the risk of positive margins, and increase the probability of a successful resection and survival.
PERSPECTIVES
Anatomical, biological, and conditional factors should be incorporated into clinical practice for the preoperative staging of patients with pancreatic ductal adenocarcinoma. These factors are essential for deciding whether to perform upfront resection or neoadjuvant chemotherapy and optimize outcomes.
