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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide

Borderline resectable pancreatic cancer

Surgery should be done 4 to 8 weeks after

neoadjuvant treatment. Surgery can be done more

than 8 weeks afterward, but if you received radiation,

then radiation-induced fibrosis might make surgery

more difficult. Hospitals that perform many pancreatic

surgeries often have better results.


At the time of surgery, your doctor may find that

the cancer has spread too far and cannot be fully

removed. In this case, surgery can’t be completed.

While you are in the operating room, the doctor may

still perform a biliary bypass procedure and/or a

duodenal bypass to prevent your tumor from causing

jaundice or intestinal obstruction in the future. Your

doctor may also do a nerve block to relieve severe


Afterwards, your treatment may depend on how

far the cancer has spread. Cancer that involves

nearby blood vessels or other structures to a

significant degree that prevents it from being able to

be completely removed by surgery is called locally

advanced unresectable pancreatic cancer. Cancer

that has spread outside the pancreas to distant sites

in the body is called metastatic pancreatic cancer.

Next steps

If the cancer was removed by surgery, see Guide

11 for adjuvant treatment recommendations. If

the cancer couldn’t be removed by surgery, see

treatment for locally advanced or metastatic

pancreatic cancer.