The Duality of Pancreatic Cancer: A local and systemic disease

Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease with a dismal 5-year survival of 10%. Currently, the only chance at long-term survival is surgical resection combined with chemotherapy. Approximately 30 to 40% of patients presents with locally advanced pancreatic cancer (LAPC), whereby the tumor encases major peripancreatic vasculature. Due to the vascular involvement, LAPC is deemed unresectable. However, the treatment landscape has evolved since the introduction of more potent chemotherapy regimens. In this context, high-volume centers have increasingly performed complex resections of LAPC with good short- and long-term outcomes.
Part I of this thesis elaborates on different strategies to expand resectability rates, by discussing different surgical techniques and the use of improved preoperative imaging. Moreover, part I highlights that, despite advancements in surgical care, surgery carries an inherent risk of complications. Besides discussing the local aspect of PDAC, this thesis also discusses the systemic nature of PDAC and the effect on survival and the challenges associated with this (part II). Finally, it will provide recommendations regarding the use of biomarkers in the postoperative follow-up of PDAC. Part III will delve into the clinical utility of known and novel biomarkers in detecting recurrence and guiding treatment decisions.