Preoperative chemotherapy is and must be a mandatory and well-established part of treatment for patients presenting with larger tumors that extend to surrounding tissues, i.e., patients with “borderline resectable” and “locally advanced” pancreatic cancer that involves, invades, and encases critical arteries and veins around the pancreas. Only in this way can we ensure the operability of such tumors and increased survival rates of patients postoperatively.

Most renowned pancreatic surgical centers in the United States choose to administer radiation therapy after chemotherapy. This happens because it has been proven that the final resection of “borderline resectable” and “locally advanced” tumors is more likely to be curative, i.e., “with clear margins” (meaning that no cancer cells are left after removal) when preceded by chemotherapy and radiation therapy. Our team is currently following this strategy. One month after the completion of the radiation treatment, we move forward with surgery to remove the tumor along with the involved artery or vein.

Most patients and their relatives often express concern that this preoperative treatment may “delay surgery” and make cancer “get worse.” In such cases, it is essential to explain to them that the exact opposite is true: our treatments kill cancer cells and shrink tumors. Following these treatments increases the chances of successfully getting a tumor removed and ensures effective long-term treatment. 

Preoperative chemotherapy has proven to be so effective in advanced tumors that it has recently started being administered to patients with smaller tumors and high tumor markers (CA 19-9). Large-scale Pan-American studies have shown that patients whose tumors have been successfully removed but have high tumor markers do not live as many years as patients who undergo the same surgery and have lower tumor markers. This strategy is now a well-established standard practice in the greatest American hospitals, such as Mayo Clinic, Massachusetts General Hospital, and MD Anderson. Our team has been implementing this strategy since 2020 to ensure successful surgery and the longest possible survival after surgery.