Dr. Ribeiro on Criteria for Determining Borderline Resectability in Pancreatic Cancer

Afonso Ribeiro, MD, medical director of Advanced Endoscopy and Gastroenterology at Memorial Healthcare System, discusses the criteria that can be used to determine whether a patient with pancreatic cancer has borderline resectable disease.

The definition of “borderline resectable” is somewhat subjective, says Ribeiro, as it varies from institution to institution. However, collaborative efforts between surgeons and medical oncologists, as well as consensus guidelines, are helping to standardize the criteria for borderline resectable disease.

Patients with borderline resectable disease typically have a lot of tumor contact with the vein or some contact with the artery, which prevents surgeons from seeing a clear tissue plane on those blood vessels, explains Ribeiro. Generally, the majority of patients with borderline resectable disease will not have an R0 resection if they’re taken to surgery. Those patients will have a higher risk of residual disease after surgery. Therefore, instead of taking patients to surgery and running the risk of heavy residual disease, patients with borderline resectable disease are given neoadjuvant therapy, concludes Ribeiro.