Management of Locally Advanced Pancreatic Cancer: Results of an International Survey of Current Practice

Bradley N. Reames, Alex B. Blair, Robert W. Krell, Vincent P. Groot, Georgios Gemenetzis, James C. Padussis, Sarah P Thayer, Massimo Falconi, Christopher L. Wolfgang, Matthew J. Weiss, Chandrakanth Are, Jin He

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Objective:The aim of this study was to investigate surgeon preferences for the management of patients with locally advanced pancreatic cancer (LAPC).Background:Select patients with LAPC may become candidates for curative resection following neoadjuvant therapy, and recent reports of survival are encouraging. Yet the optimal management approach remains unclear.Methods:An extensive electronic survey was systematically distributed by email to an international cohort of pancreas surgeons. Data collected included practice characteristics, management preferences, attitudes regarding contraindications to surgery, and 6 clinical vignettes of patients that ultimately received a margin negative resection (with detailed videos of post-neoadjuvant imaging) to assess propensity for surgical exploration if resection status is not known.Results:A total of 153 eligible responses were received from 4 continents. Median duration of practice is 12 years (interquartile range 6-20) and 77% work in a university setting. Most surgeons (86%) are considered high volume (>10 resections/yr), 33% offer a minimally-invasive approach, and 50% offer arterial resections in select patients. Most (72%) always recommend neoadjuvant chemotherapy, and 65% prefer FOLFIRINOX. Preferences for the duration of chemotherapy varied widely: 39% prefer ≥2 months, 43% prefer ≥4 months, and 11% prefer ≥6 months. Forty-one percent frequently recommend neoadjuvant radiotherapy, and 53% prefer 5 to 6 weeks of chemoradiation. The proportion of surgeons favoring exploration following neoadjuvant varied extensively across 5 vignettes of LAPC, from 14% to 53%. In a vignette of oligometastatic liver metastases, 31% would offer exploration if a favorable therapy response is observed.Conclusions:In an international cohort of pancreas surgeons, there is substantial variation in management preferences, perceived contraindications to surgery, and the propensity to consider exploration in LAPC. These results emphasize the importance of a robust and nuanced multidisciplinary discussion for each patient, and suggest an evolving concept of "resectability.".

Original languageEnglish (US)
Pages (from-to)1173-1181
Number of pages9
JournalAnnals of surgery
Issue number6
StatePublished - Jun 1 2021


  • locally advanced pancreas cancer
  • multidisciplinary management
  • pancreas cancer
  • pancreas surgery
  • survey research

ASJC Scopus subject areas

  • Surgery


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