“Borderline” and “locally advanced” are two terms used to describe pancreatic cancer at the time of diagnosis through a CT or an MRI scan. These terms describe the level of contact, involvement, or blockage of major and critical arteries and veins around and behind the pancreas due to the tumor. Such arteries and veins include the portal vein, the superior mesenteric vein, the hepatic artery, and the superior mesenteric vein. The term “borderline resectable” DOES NOT mean that a tumor can or cannot be resected, nor does it mean that the decision to move forward with resection will be made during surgery. “Borderline resectable tumor” is a tumor that contacts, presses against, or invades the portal vein or hepatic and mesenteric arteries and, thus, requires preservation/restoration of arterial supply or resection of the involved part of the portal vein.  

“Borderline resectable” or “locally advanced” tumors are generally considered unresectable because any effort to preserve veins and arteries during surgery is extremely dangerous. The only way to get a borderline resectable or locally advanced tumor resected is to remove it along with the involved part of the artery and/or the vein. Our team was the first in Greece to systematically perform such procedures, i.e., resection of tumor and resection of involved veins and arteries. We were also the first to publish a series of 24 cases in which the involved portal or mesenteric vein was resected. Our article was published in the specialized Journal of Pancreatic Cancer in September 2019 (https://www.liebertpub.com/doi/10.1089/pancan.2019.0013). We were the first to perform the Appleby procedure in Greece and published our results at the International Journal of Surgery in October 2020 (https://doi.org/10.1016/j.ijscr.2020.09.194).

Preoperative neoadjuvant chemotherapy or radiation therapy are prerequisites for such a surgical procedure as they lead to CA 19-9 tumor marker decrease and possibly tumor shrinkage. Of course, only 30-40% of such tumors can be successfully resected even after chemotherapy. Surgeries that require vascular removal, bypass, or graft transplant require a highly experienced surgical team that performs such surgeries often and has all necessary credentials. 

Such highly acknowledged credentials include:

1. scientific publications in reputable scientific journals that have gone thorough checks, and reviews, and are held in high regard by internationally renowned pancreatic surgeons, and 
2. testimonials from patients who have lived years after the removal of tumors that were initially considered “inoperable.”