Treatment of resectable pancreatic cancer with high probability of R0 resection

This protocol addresses patients with pancreatic cancer who have been radiologically assessed and identified as having a high probability of achieving complete surgical clearance — defined as no cancer cells within 1 mm of any resection margin (R0) — with no tumour-vessel contact.

Clinical scenario Resectable pancreatic cancer where radiological evaluation indicates a high probability of R0 resection and no tumour involvement of adjacent vessels. For these patients, initial surgery is the standard of care.

Treatment approach (partial overview) Surgical resection is the cornerstone of management, with the operative approach determined by tumour location within the pancreas. Resection is accompanied by standard lymphadenectomy. Perioperative thromboprophylaxis is also addressed in the full protocol.

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References

DOI: 10.1016/j.annonc.2023.08.009

Following radiological evaluation, only patients with a high probability of surgical resection with no tumour at the margin (R0; defined as no cancer cells within 1 mm of all resection margins) are good candidates for upfront surgery.

For resectable tumours, initial surgery remains the standard of care.

Patients with tumours in the head of the pancreas undergo pancreatoduodenectomy (Whipple procedure).

For patients with tumours in the body or tail, distal pancreatectomy, including resection of the body and tail of the pancreas and spleen, is usually undertaken.

Standard lymphadenectomy is recommended and should involve the removal of 16 lymph nodes to allow adequate pathological staging of the disease [IV, A].

Patients undergoing surgery should receive perioperative thromboprophylaxis with either unfractionated heparin or low-molecular-weight heparin (LMWH), unless contraindicated [I, A].

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