Surgery After Response to Chemotherapy for Locally Advanced Pancreatic Ductal Adenocarcinoma: A Guide for Management

Authors: Zhi Ven Fong MD, MPH 1 and Cristina R. Ferrone MD 1
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  • 1 Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Because of the biologic aggressiveness and late presentation of pancreatic ductal adenocarcinoma (PDAC), up to 80% of patients have locally advanced or metastatic disease at presentation. The success of multiagent chemotherapy regimens in the management of metastatic disease has been translated to patients with locally advanced PDAC. Both FOLFIRINOX (fluorouracil/folinic acid/irinotecan/oxaliplatin) and gemcitabine/nab-paclitaxel are used to downstage locally advanced PDAC to render it eligible for resection with curative intent. This paradigm shift has significantly expanded the pool of patients who are eligible for resection with curative intent. However, the generalizability of present studies and the patient selection process are unclear. This article provides an evidence-based review of patient selection considerations and management algorithms, and details our institution’s approach to patients with locally advanced PDAC after preoperative chemotherapy.

Submitted August 23, 2020; accepted for publication January 14, 2021.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Cristina R. Ferrone, MD, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114-3117. Email: cferrone@mgh.harvard.edu
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