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Surgery. 2014 Jun;155(6):977-88. doi: 10.1016/j.surg.2014.02.001. Epub 2014 Feb 7.

Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS).

Author information

  • 1Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  • 2Department of HPB Surgery, Hôpital Edouard Herriot, Lyon, France.
  • 3Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
  • 4First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
  • 5Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
  • 6Department of General Surgery, Mayo Clinic, Jacksonville, FL.
  • 7Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
  • 8Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
  • 9Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
  • 10Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland.
  • 11Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain.
  • 12First Department of Surgery, Agia Olga Hospital, Athens, Greece.
  • 13Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France.
  • 14Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
  • 15Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
  • 16Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  • 17Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy.
  • 18Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK.
  • 19Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Centre, Mumbai, India.
  • 20Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
  • 21St. Luke's Clinic - Center For Pancreatic and Liver Diseases, Boise, ID.
  • 22Department of Gastrointestinal Surgery, Penn Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
  • 23Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
  • 24Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address:



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.


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.


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.


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.

Copyright © 2014 Mosby, Inc. All rights reserved.

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