Treatment of Resectable Pancreatic Cancer with High Probability of R0 Resection
This protocol applies to patients with pancreatic cancer where radiological staging confirms that surgical removal with clear margins is achievable — specifically, no tumour-vessel contact and a high probability of R0 resection.
Clinical scenario
Following radiological evaluation, 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 — and no tumour-vessel contact are candidates for this pathway. For this resectable disease, initial surgery remains the standard of care.
Post-surgical treatment approach
Following resection, adjuvant chemotherapy is strongly recommended, with the choice of regimen determined by patient performance status and individual eligibility.
The complete regimen options, eligibility criteria, and sequencing are available in the full protocol →
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.
- Following resection of PC, completion of 6 months of adjuvant ChT is strongly recommended [I, A].
- Adjuvant mFOLFIRINOX is recommended for patients with resected PC and ECOG PS 0-1 [I, A; ESMO-MCBS v1.1 score: A].
- In patients who are not candidates for mFOLFIRINOX (age >75 years, ECOG PS 2 or contraindication to mFOLFIRINOX), gemcitabine-capecitabine is an alternative option [I, B; ESMO-MCBS v1.1 score: A].
- Adjuvant gemcitabine or 5-FU-LV should be limited to frail patients [I, B].
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