Treatment Sequencing for Resectable Disease

Abstract

The management of resectable or localized pancreatic cancer (PC) remains controversial. Although randomized controlled trials have demonstrated a benefit in survival associated with adjuvant therapy for PC, most of these patients do not receive postoperative chemotherapeutic treatment due to the high rate of complications associated with pancreatic surgery. Recognizing that surgery may be necessary but usually not sufficient for cure, there has been growing interest in neoadjuvant treatment sequencing, which benefits patients with both localized and micrometastatic PC by ensuring the delivery of systemic therapies. For patients with truly localized disease, neoadjuvant therapy ensures the delivery of all components of the multimodality treatment. For patients who have clinically occult metastatic disease, neoadjuvant therapy allows for the early delivery of systemic therapy and avoids the morbidity and mortality of a surgical resection which would provide no oncologic benefit. This chapter details the rationale of treatment sequencing for resectable PC and provides specific recommendations for staging and treatment sequencing for patients with resectable pancreatic disease.