Borderline resectable pancreatic ductal adenocarcinoma: a narrative review

Borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) is a well-recognized entity with specific characteristics. Previously considered inoperable, these tumors are now increasingly resectable due to advances in neoadjuvant chemotherapy. This review synthesizes current knowledge on diagnostic, therapeutic, and management approaches for pancreatic ductal adenocarcinoma, especially for BR disease. It covers the definition, criteria, and surgical management, along with various clinical challenges in the diagnosis of borderline disease. Neoadjuvant therapy is the treatment of choice before surgery, but there are still limited data on the selection of optimal therapy and on the early identification of non-responders. Multidetector computed tomography, along with CA19-9 and positron emission tomography, are being used to evaluate resectability after neoadjuvant therapy. Pancreatic resection for PDAC is one of the most complex procedures in abdominal surgery due to the technical and oncological challenges associated with its aggressive growth. Despite these options, management remains challenging.