[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-465533-105":59,"doc-detail-465533-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","diagnosis-and-surgical-management-for-advanced-pancreatic-cancer-requiring-vascular-resection","Diagnosis and Surgical Management for Advanced Pancreatic Cancer Requiring Vascular Resection","","Pancreatic ductal adenocarcinoma remains a highly aggressive malignancy where survival gains have been modest despite recent advances. Careful preoperative evaluation is required to define resectability and plan surgery. High-resolution CT, MRI, and endoscopic ultrasound help stage vascular involvement and stratify patients using international criteria. For borderline and locally advanced disease, neoadjuvant therapy can downsize tumors, increase R0 resection rates, and support long-term survival and quality of life. When vascular invasion limits resectability, venous resection with reconstruction may enable R0 outcomes; arterial resection is controversial and alternative strategies such as arterial divestment are discussed. Candidate selection is crucial for improving resectability and outcomes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/diagnosis-and-surgical-management-for-advanced-pancreatic-cancer-requiring-vascular-resection/465533/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/diagnosis-and-surgical-management-for-advanced-pancreatic-cancer-requiring-vascular-resection/465533.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1786070896","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is careful preoperative evaluation important in advanced pancreatic cancer requiring vascular resection?","Question",{"text":112,"@type":113},"It defines resectability and guides surgical planning by assessing vascular involvement and staging using modern imaging and international criteria.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do neoadjuvant therapies influence outcomes in borderline and locally advanced PDAC?",{"text":117,"@type":113},"Neoadjuvant therapy can downsize tumors, increase the chance of negative-margin (R0) resection, and improve survival compared with upfront surgery or palliative chemotherapy.",{"name":119,"@type":110,"acceptedAnswer":120},"What is the role of venous versus arterial resection in achieving R0 resection?",{"text":121,"@type":113},"Venous involvement is commonly managed with resection and reconstruction to permit R0 surgery in selected patients. Arterial resection is more controversial and typically reserved for strictly selected cases due to higher risk and limited demonstrated benefit.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},465533,1791178829,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},549768072016,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review  \nDiagnosis and Surgical Management for Advanced Pancreatic Cancer Requiring Vascular Resection  \nSolonas Symeou, Evangelos D. Lolis and Georgios K. Glantzounis *  \nAcademic Editor: Spiros G. Delis  \nReceived: 25 November 2025  \nRevised: 23 December 2025  \nAccepted: 26 December 2025  \nPublished: 28 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nHPB Unit, Department of Surgery, Faculty of Medicine, University of Ioannina and University Hospital of  \nIoannina, 45110 Ioannina, Greece; [md07011@uoi.gr](md07011@uoi.gr) (S.S.); [vlolis@uoi.gr](vlolis@uoi.gr) (E.D.L.)  \n* Correspondence: [gglantzounis@uoi.gr](gglantzounis@uoi.gr)  \nAbstract  \nPancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive malignancies, with overall survival outcomes that have improved only modestly in recent years. Careful preoperative evaluation is essential for defining resectability and planning surgery. Modern imaging modalities, including high-resolution, contrast-enhanced CT, MRI and endoscopic ultrasound, provide a detailed assessment of vascular involvement and allow accurate staging according to various international criteria and consensus statements. In borderline and locally advanced cases, neoadjuvant therapy can aid in downsizing the tumor and increasing the likelihood of achieving negative margin resection (R0), offering long-term survival along with quality of life. When vascular invasion limits resectability, venous resection and reconstruction may permit an R0 resection in patients with borderline resectable disease that is both technically operable and physiologically tolerable for the patient. Arterial resection, however, remains controversial and is rarely justified because of its limited perioperative and survival benefits. Arterial divestment has emerged as an interesting alternative, allowing tumor clearance while avoiding full arterial reconstruction. Vascular reconstructions can be achieved through venorrhapy, end-to-end anastomosis, or segmental replacement using either autologous or synthetic grafts. With the advances in neoadjuvant treatment, the appropriate selection of candidates for vascular resection significantly increases the resectability rate, offering long-term survival along with satisfactory quality of life. In this review, a detailed literature review is performed regarding the best strategies in the diagnosis and surgical management of patients with borderline resectable and locally advanced pancreatic cancer requiring vascular resection.  \nKeywords: pancreatic adenocarcinoma; PDAC; borderline resectable; locally advanced; vascular reconstruction; venous resection; arterial resection  \n1. Introduction  \nPancreatic ductal adenocarcinoma (PDAC) is a high-burden malignancy with rising incidence and remains among the leading causes of cancer-related death worldwide [1] . Most patients present with regionally advanced or metastatic disease at diagnosis, such that curative options are limited and only about 10 to 20% are candidates for upfront resection [2–4] .  \nDespite these constraints, therapeutic advances over the past decade have yielded remarkable improvements [5,6] . Adjuvant therapy improves outcomes after resection, with durable benefit confirmed at long-term follow-up [7–9] . Borderline resectable (BR) and locally advanced (LA) PDAC constitute a substantial proportion of cases, estimated at  \napproximately 40%, for which neoadjuvant therapy (NAT) is now a cornerstone of care [10] . Across multiple studies, NAT increases the likelihood of resectability and margin-negative resection (R0) and is associated with improved survival compared with upfront surgery or palliative chemotherapy alone [11–14] .  \nVascular involvement is a pivotal determinant of operability and oncologically acceptable resection in patients with P","cbCainhRIlrIGvjZ","https://ap.wps.com/l/cbCainhRIlrIGvjZ","pdf",648383,25,"English","# Abstract\n# 1. Introduction\n# 2. Materials and Methods","[{\"question\":\"Why is careful preoperative evaluation important in advanced pancreatic cancer requiring vascular resection?\",\"answer\":\"It defines resectability and guides surgical planning by assessing vascular involvement and staging using modern imaging and international criteria.\"},{\"question\":\"How do neoadjuvant therapies influence outcomes in borderline and locally advanced PDAC?\",\"answer\":\"Neoadjuvant therapy can downsize tumors, increase the chance of negative-margin (R0) resection, and improve survival compared with upfront surgery or palliative chemotherapy.\"},{\"question\":\"What is the role of venous versus arterial resection in achieving R0 resection?\",\"answer\":\"Venous involvement is commonly managed with resection and reconstruction to permit R0 surgery in selected patients. Arterial resection is more controversial and typically reserved for strictly selected cases due to higher risk and limited demonstrated benefit.\"}]","Diagnosis and Surgical Management for Advanced Pancreatic Cancer Requiring Vascular Resection | PDF",1790769740,63]