Borderline Resectable Pancreatic Cancer: A Shanghai Review Guide

First confirm what the label describes

This discussion concerns exocrine pancreatic cancer, usually pancreatic ductal adenocarcinoma, rather than pancreatic neuroendocrine tumours or an unexplained pancreatic mass. Borderline resectable disease may involve nearby blood vessels in a way that makes complete removal difficult. It is not automatically metastatic disease, and it is not interchangeable with clearly resectable or locally advanced disease. Ask the original team which imaging findings led to the label and whether the classification was agreed by a multidisciplinary team. A second report using different terminology may reflect a different assessment rather than a change in the cancer.

Sources and references: [1]

Review the vessels on the actual images

Send the original contrast-enhanced CT or MRI series, the report and examination date. A sentence saying “vascular involvement” is not a complete surgical assessment: the reviewing clinicians need to identify the vessel, extent of tumour contact and whether safe removal and reconstruction appear feasible. They must also assess disease elsewhere. Ask whether the existing scan answers these questions or whether updated, appropriately performed imaging is needed. A clear explanation of the anatomical obstacle is more useful than a yes-or-no promise about surgery based only on a translated report.

Sources and references: [1] [3]

Ask why treatment comes before or after surgery

For some people, treatment before surgery, commonly chemotherapy and sometimes chemoradiation, is considered to address disease and improve the prospects of a later operation. It also creates a point at which the team can reassess the cancer and the person’s ability to tolerate surgery. This does not mean every borderline case follows the same regimen. Ask what supports the proposed sequence, what alternatives were discussed, and whether tissue confirmation or additional staging is required before starting. Do not interrupt existing treatment while awaiting an overseas opinion without discussing the timing with the treating team.

Sources and references: [1] [2]

Define the next decision before starting

Agree what the team will review after the planned treatment: updated imaging, evidence of spread, the relationship to vessels, treatment tolerance, nutrition and general fitness. A smaller tumour is encouraging in some circumstances but does not by itself establish that an operation is technically possible or appropriate. Conversely, a decision should not rely on a single size measurement without examining the complete clinical picture. Request a written account of what would support surgical exploration, what would favour further treatment, and how care would continue if resection remains unsuitable.

Sources and references: [1] [2]

Treat obstruction and nutritional problems as part of care

Weight loss, poor intake, pain and jaundice can affect how well someone tolerates treatment. Bring weight changes, dietary problems, current medicines and any biliary stent or drainage records. Clinicians may need to address obstruction, pain or digestion, including prescribing pancreatic enzymes when appropriate. Symptom-relieving procedures are not the same as removing the cancer. Fever or significant deterioration, particularly with jaundice or an existing stent, needs prompt local assessment rather than waiting for a travel appointment. Ask the current team to establish a safe plan for symptoms and treatment side effects before departure.

Sources and references: [1] [2]

Use a pancreatic multidisciplinary review for a defined question

For borderline resectable pancreatic cancer, the greatest value is a shared treatment map across surgery, imaging and oncology. The pancreatic and hepatobiliary team at Fudan University Shanghai Cancer Center brings together surgeons, pathologists, medical and radiation oncologists, imaging specialists and endoscopists. A Shanghai review can clarify the vessel involvement, the reason for treatment before surgery and the criteria for reconsidering an operation. Explore our Pancreatic cancer guide, then let eastmedgo connect your case with a team suited to this decision.

Sources and references: [3]

Build one chronological record and a realistic estimate

Prepare pathology reports and information on available slides or blocks, original scans, treatment names and dates, dose changes, adverse effects, blood results and any procedure reports. Include a short question list rather than separate contradictory summaries. Request estimates for consultation, pathology review, repeat imaging, systemic treatment and, if later indicated, surgery and recovery. Clarify which costs depend on findings and whether further treatment can continue at home. Allow for additional visits, an accompanying person and changes to travel dates; an assessment visit and a surgical admission should not be budgeted as the same event.

Sources and references: [1] [2] [3]

Leave with a conditional plan, not only an opinion

A useful written conclusion records the diagnosis, reason for the resectability category, recommended next step, planned reassessment and responsible team. If surgery is proposed, discuss major operative risks, the possibility that complete removal will not be achievable, prolonged recovery and postoperative support. If it is not proposed, ask which cancer-directed and supportive options remain. Arrange how the Shanghai opinion will reach the home team so that continuing care does not depend on the patient translating complex instructions alone. eastmedgo can organise the records needed for reassessing pancreatic surgery from vessel involvement and treatment dates, match you with Shanghai specialists and coordinate bilingual communication and return-home handover. To see how coordination works, read about eastmedgo's services or contact us with your records.

Sources and references: [1] [2] [3]

Common questions