Background: Borderline resectable pancreatic cancer (BRPC) is frequently encountered in high-volume centers. It has various definitions among different societies or institutions. Patients and Methods: In this landmark series review, we summarize the critical randomized controlled studies that have defined the neoadjuvant and surgical management of BRPC. Results: Surgical resection after neoadjuvant treatment is the mainstay of treatment and should involve margin-negative resection with regional lymphadenectomy. Several recently completed randomized controlled clinical trials have defined the role of neoadjuvant chemotherapy for patients with BRPC. The utilization of chemoradiation remains controversial. Conclusions: The definition of BRPC goes beyond the anatomic relationship between the tumor and vessels. We need to include biological and conditional dimensions. Neoadjuvant chemotherapy and surgery are associated with improved outcomes of BRPC. Understanding the molecular features of pancreatic cancer should lead to the discovery of novel biomarkers as well as a more personalized approach to guide individualized therapy.
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