NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Borderline resectable pancreatic cancer
shows the recommended tests and
treatments for borderline resectable pancreatic
cancer when your doctor plans to do surgery
without neoadjuvant treatment. First, you will have a
laparotomy—an up-and-down surgical cut through the
abdomen. This lets your doctor see the tumor in your
pancreas along with other organs and tissues nearby.
There is more than one type of surgery for pancreatic
cancer. Which type of surgery is recommended
depends on the size and location of the cancer in
your pancreas. Read Part 3 on page 24 for details.
NCCN experts recommend that surgery for pancreatic
cancer should only be done at a hospital that does
more than 15 pancreatic cancer surgeries each year.
Hospitals that perform many pancreatic surgeries
often have better results.
At the beginning of surgery, your doctor may
find that the cancer has spread too far to all be
In this case, surgery can’t be completed. At
this time, you will have a biopsy to confirm pancreatic
cancer if not done previously. A biopsy is the removal
of tissue from your body to test for cancer cells. The
next treatments depend on if you have symptoms of
jaundice. Jaundice is a yellowing of the eyes and skin
due to a buildup of bilirubin in the body. A pancreatic
tumor can cause jaundice by blocking a bile duct so
the bilirubin can’t drain out of the liver.
If you don’t have jaundice,
then your doctor may do
a duodenal bypass. This is a surgery to re-route the
path eaten food takes out of your stomach to the
duodenum, the first part of the small intestine. This
surgery may be done if the tumor is blocking or is at
risk of blocking food from passing out of your stomach.
If you have severe pain, your doctor may inject alcohol
into the nerves near the pancreas to destroy them to
relieve the pain. This is called a nerve block.
Chart 5.3.3 Planned surgery
Completed surgery to
Cancer can’t be
removed by surgery
Biopsy if not
If no jaundice:
Possible duodenal bypass +
Stent or biliary bypass +
Duodenal bypass +
Nerve block for pain