title: Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS).
abstract: BACKGROUND
  This position statement was developed to expedite a consensus on definition and treatment for borderline resectable pancreatic ductal adenocarcinoma (BRPC) that would have worldwide acceptability.
  
  
  METHODS
  An international panel of pancreatic surgeons from well-established, high-volume centers collaborated on a literature review and development of consensus on issues related to borderline resectable pancreatic cancer.
  
  
  RESULTS
  The International Study Group of Pancreatic Surgery (ISGPS) supports the National Comprehensive Cancer Network criteria for the definition of BRPC. Current evidence supports operative exploration and resection in the case of involvement of the mesentericoportal venous axis; in addition, a new classification of extrahepatic mesentericoportal venous resections is proposed by the ISGPS. Suspicion of arterial involvement should lead to exploration to confirm the imaging-based findings. Formal arterial resections are not recommended; however, in exceptional circumstances, individual therapeutic approaches may be evaluated under experimental protocols. The ISGPS endorses the recommendations for specimen examination and the definition of an R1 resection (tumor within 1 mm from the margin) used by the British Royal College of Pathologists. Standard preoperative diagnostics for BRPC may include: (1) serum levels of CA19-9, because CA19-9 levels predict survival in large retrospective series; and also (2) the modified Glasgow Prognostic Score and the neutrophil/lymphocyte ratio because of the prognostic relevance of the systemic inflammatory response. Various regimens of neoadjuvant therapy are recommended only in the setting of prospective trials at high-volume centers.
  
  
  CONCLUSIONS
  Current evidence justifies portomesenteric venous resection in patients with BRPC. Basic definitions were identified, that are currently lacking but that are needed to obtain further evidence and improvement for this important patient subgroup. A consensus for each topic is given.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Faik G
authors.initials: FG
authors.lastname: Uzunoglu
authors.affiliation: Department of HPB Surgery, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.affiliation: Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
authors.forename: Clem
authors.initials: C
authors.lastname: Imrie
authors.affiliation: First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Milicevic
authors.affiliation: Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors.forename: Aken A
authors.initials: AA
authors.lastname: Sandberg
authors.affiliation: Department of General Surgery, Mayo Clinic, Jacksonville, FL.
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun
authors.affiliation: Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Büchler
authors.affiliation: Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Charnley
authors.affiliation: Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Conlon
authors.affiliation: Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Laureano Fernandez
authors.initials: LF
authors.lastname: Cruz
authors.affiliation: First Department of Surgery, Agia Olga Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.affiliation: Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France.
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhutt
authors.affiliation: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.affiliation: Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.affiliation: Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.affiliation: St. Luke's Clinic - Center For Pancreatic and Liver Diseases, Boise, ID.
authors.forename: William
authors.initials: W
authors.lastname: Traverso
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.affiliation: Department of Gastrointestinal Surgery, Penn Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Charles
authors.initials: C
authors.lastname: Vollmer
authors.affiliation: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: izbicki@uke.de.
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011379:Prognosis