Borderline resectable pancreatic cancer (BRPC) is a new diagnosis that blurs the line between resectable and locally progressed pancreatic cancer. In general, pancreatic cancer that is borderline resectable is neither clearly resectable nor definitely unresectable, but rather suggests a higher risk of incomplete resection in the case of early surgery. Numerous associations offer definitions for borderline resectable pancreatic cancer, however, there is currently no commonly accepted classification. Borderline resectable is defined as more than 180 degrees of venous involvement but less than 180 degrees of arterial involvement, whereas locally progressed is defined as more than 180 degrees of arterial involvement.
Sometimes, doctors state that pancreatic cancer is “borderline resectable.” The majority of localized pancreatic cancer patients who undergo surgery, whether with or without adjuvant therapy, go on to develop metastatic disease, indicating that surgery alone is insufficient for curing the disease and that micrometastases are present at the time of diagnosis even when they are not clinically obvious.
Borderline Resectable Pancreatic Cancer Prognosis
A prognostic factor is a consideration that the doctor takes into account when making a prognosis, such as a patient’s age or whether or not they smoke. The prognosis of cancer’s response to therapy is affected by several factors.
The prognosis is mostly better for pancreatic cancer if it is discovered and treated earlier. The term “resectability” refers to a tumor’s potential for total removal after surgery. It is among the most significant elements that determine the prognosis for patients with pancreatic cancer. The prognosis is better for tumors that are eliminated surgically (called resectable).
Pancreatic cancer is particularly difficult to diagnose because its symptoms sometimes don’t appear until the disease is already grown. Because of this, the majority of cases (up to 80%) are discovered at later, more challenging stages.
Borderline Resectable Pancreatic Cancer Survival Rate
In the US, pancreatic cancer ranks fourth in terms of cancer-related fatalities. Even though the only curative therapy is still surgical resection, more than 80% of patients possess incurable illnesses when they are first diagnosed. Unfortunately, despite advancements in diagnostic imaging, surgical technique, and alternatives for chemotherapeutic treatment, only small increases in patient survival are observed for the past several decades. To achieve long-term life and cure, however, it is still obvious that surgical resection is necessary.
Approximately 15 to 20% of pancreatic cancers are resectable. Cancers in stages I and II are among them. Rarely, locally advanced stage III cancers that are ordinarily deemed incurable (do not qualify for surgery) are described as “borderline” and are mostly removed if the patient finds access to a skilled, experienced surgeon.
Many people develop new tumors despite treatment. Patients with resected tumors live for an average of 2.5 years following diagnosis and possess a five-year survival rate of 20 to 30%.
Borderline Resectable Pancreatic Cancer Treatment
There are a few distinct anatomic classifications for this stage of disease, but most experts believe that the involvement of reconstructible mesenteric arteries by the tumor is the defining anatomic feature that places borderline resectable tumors between anatomically resectable and unresectable (locally progressed) tumors. Although the best strategy is unknown, systemic chemotherapy followed by chemoradiation is a sensible approach, and there is widespread agreement that such malignancies are handled with neoadjuvant chemotherapy and/or chemoradiation before resection.
The use of more modern treatments, such as FOLFIRINOX, is primarily selected following the protocol for treating this stage of pancreatic cancer. Maintaining biliary decompression for up to six months is also necessary for many patients undergoing neoadjuvant therapy for pancreatic head tumors.
Patients who initially appear with resectable tumors get a better chance of surviving for a longer period if they get multimodal treatment for their pancreatic cancer. To improve these patients’ short-term and long-term oncologic outcomes, a team of doctors from different fields often performs jointly.