title: [Resection for advanced pancreatic cancer following multimodal therapy].
abstract: Pancreatic cancer patients presenting with borderline resectable or locally advanced unresectable tumors remain a therapeutic challenge. Despite the lack of high quality randomized controlled trials, perioperative neoadjuvant treatment strategies are often employed for this group of patients. At present the FOLFIRINOX regimen, which was established in the palliative setting, is the backbone of neoadjuvant therapy, whereas local ablative treatment, such as stereotactic irradiation and irreversible electroporation are currently under investigation. Resection after modern multimodal neoadjuvant therapy follows the same principles and guidelines as upfront surgery specifically regarding the extent of resection, e.g. lymphadenectomy, vascular resection and multivisceral resection. Because it is still exceedingly difficult to predict tumor response after neoadjuvant therapy, a special treatment approach is necessary. In the case of localized stable disease following neoadjuvant therapy, aggressive surgical exploration with serial frozen sections at critical (vascular) margins might be necessary to minimize the risk of debulking procedures and maximize the chance of a curative resection. A multidisciplinary and individualized approach is mandatory in this challenging group of patients.
authors.affiliation: Department of Surgery, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, L7 8XP, Liverpool, UK. kleeff@liverpool.ac.uk.|Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. kleeff@liverpool.ac.uk.|Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland. kleeff@liverpool.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Kleeff
authors.affiliation: Technische Universität München, München, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Stöß
authors.affiliation: Department of Surgery, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, L7 8XP, Liverpool, UK.
authors.forename: V
authors.initials: V
authors.lastname: Yip
authors.affiliation: Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D018274:Electroporation; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008197:Lymph Node Excision / Q000379:methods; D020360:Neoadjuvant Therapy / Q000379:methods; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D011379:Prognosis; D016634:Radiosurgery; D016019:Survival Analysis
keywords: Ablation techniques; Lymphadenectomy; Neoadjuvant therapy; Surgical procedures, operative; Survival