title: Borderline resectable pancreatic cancer: rationale for multidisciplinary treatment.
abstract: BACKGROUND
  Borderline resectable pancreatic cancer (BRPC) appears to be most frequently related to a positive surgical margin and has a poor prognosis after resection. However, few reports are available on differences in tumor characteristics and prognoses among resectable pancreatic cancer (PC), BRPC, and unresectable PC.
  
  
  METHODS
  Records of 133 patients resected for pancreatic ductal adenocarcinoma and 185 patients treated as locally advanced PC (LAPC) were reviewed.
  
  
  RESULTS
  Twenty-four patients who initially underwent resection (BRPC-s) and 10 patients who were initially treated as LAPC (BRPC-n) met the criteria for BRPC. Prognosis of BRPC was significantly better than that of unresectable PC, but was significantly worse than that of resectable PC. BRPC-s showed more frequent nerve plexus invasion (P < 0.01), portal vein invasion (P < 0.01), and loco-regional recurrence (P = 0.03) than resectable PC. The positive surgical margin rate was not significantly higher in BRPC-s (29%) than in resectable PC (19%) (P = 0.41).
  
  
  CONCLUSIONS
  BRPC had a poorer prognosis with more local failure than resectable PC although prognosis of BRPC was significantly better than that of unresectable PC. Considering the tumor and treatment characteristics, multidisciplinary treatment including resection is required for BRPC.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. shtakaha@east.ncc.go.jp
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Syuichi
authors.initials: S
authors.lastname: Mitsunaga
authors.forename: Kohei
authors.initials: K
authors.lastname: Nakachi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents