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The surgeon's verdict on whether the tumour can be completely removed. Resectable means yes; unresectable means it has wrapped around vital vessels, is too extensive or the patient is too frail; borderline means maybe, especially after chemotherapy shrinks it.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
Resectability is judged on imaging by involvement of arteries and veins (pancreatic cancer's borderline definitions concern the superior mesenteric vessels), extent of nodal disease (N2-3 in lung cancer) and liver remnant volume, and is not the same as stage: some stage IV colorectal liver metastases are resectable and some stage II pancreatic tumours are not. Unresectable does not mean incurable: stage III lung cancer is cured by chemoradiation plus durvalumab in a third of patients, and 'conversion therapy' (FOLFOXIRI-bevacizumab in liver metastases, RAS inhibitors in pancreatic cancer) turns some unresectable cancers into resectable ones. Multidisciplinary review is required because surgeons differ in what they will attempt.
Together with NORPACT-1 this left the neoadjuvant question for resectable disease open: FOLFIRINOX before surgery is not proven superior to alternatives, and the comparison against upfront surgery with adjuvant modified FOLFIRINOX is what PREOPANC-3 and Alliance A021806 are running.
The trial that made neoadjuvant treatment standard for borderline resectable disease and opened the still unresolved question for resectable disease, which PREOPANC-2, NORPACT-1, PREOPANC-3 and Alliance A021806 inherited.
Every treatment on this roadmap is either a way to reach this operation, a way to make it work better, or a substitute for patients who cannot have it.
Shares Alliance A021806, Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial, Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial.
Shares Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection), Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Whipple procedure (pancreaticoduodenectomy), Resection margins (R0 / R1 / R2).
Shares Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial, Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Borderline resectable pancreatic ductal adenocarcinoma.
Shares Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial, Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Borderline resectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma.
Shares Alliance A021806, Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors.
Shares Treatment of carcinoma of the ampulla of Vater, Whipple procedure (pancreaticoduodenectomy), Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question.
Shares Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed, Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question.
Shares NEOLAP, SWOG S1505, CONKO-007, Alliance A021501.