Resectable, borderline resectable, and locally advanced pancreatic cancer: what does it matter?

Pancreatic adenocarcinoma represents a significant cause of morbidity and mortality in the modern era. Despite advances in the management of unresectable and advanced disease, the only potential avenue for cure at this time is resection. As our radiographic and surgical techniques have improved, we are better able to select patients who are the best candidates for a margin-negative resection, with or without the use of preoperative therapy. There is an emerging consensus on the definition of borderline resectable pancreatic cancer, but much work still needs to be done given the heterogeneous patient population, intervention, and outcome metrics used in previous retrospective and prospective studies. When designing future prospective trials of novel preoperative approaches, standardization of the stage of disease for the study population is essential to allow for accurate interpretation of study results. Ultimately, to make significant progress in localized pancreatic cancer, we urgently need effective novel therapeutic agents used in an optimal sequence with surgery.