Borderline Resectable and Locally Advanced Pancreatic Cancer: Advances in Neoadjuvant Therapy and Surgical Management

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal solid malignancies, with borderline resectable (BR-PC) and locally advanced pancreatic cancer (LA-PC) accounting for a substantial proportion of new diagnoses. Historically associated with poor resectability and limited survival, these disease stages have become a major focus of therapeutic innovation. Advances in multi-agent neoadjuvant chemotherapy, refined radiotherapy techniques, improved patient selection, and evolving approaches to vascular resection and reconstruction have transformed the management of BR-PC and LA-PC. Consequently, treatment has shifted from an upfront surgical approach toward a multidisciplinary strategy integrating systemic therapy, careful restaging, and technically complex surgery to maximize oncologic outcomes.

Despite these advances, several important challenges remain. There is no consensus regarding the optimal neoadjuvant regimen, treatment duration, or criteria for assessing treatment response and surgical candidacy. Radiologic evaluation following neoadjuvant therapy remains imperfect, while biomarkers and circulating tumor DNA continue to emerge as promising adjuncts for response assessment and patient selection. Furthermore, variability in definitions of resectability, institutional expertise, and approaches to vascular resection limits comparison across studies and highlights the need for greater standardisation.

This Research Topic aims to bring together clinical, surgical, and translational research addressing the contemporary management of BR-PC and LA-PC, with particular emphasis on the interplay between neoadjuvant therapy and surgical innovation. We welcome original research, clinical trials, retrospective and prospective cohort studies, systematic reviews and meta-analyses, technical reports, and expert perspectives addressing topics including, but not limited to:

• Neoadjuvant chemotherapy and chemoradiotherapy strategies for BR-PC and LA-PC;
• Radiologic, biochemical, molecular, and pathological assessment of treatment response and resectability;
• Surgical techniques and outcomes of venous and arterial resection and reconstruction;
• Predictors of pathologic response and their association with recurrence and survival;
• Biomarkers, liquid biopsy, and circulating tumor DNA for treatment monitoring and patient selection;
• Perioperative management, surgical outcomes, and postoperative recovery following complex pancreatic resections;
• Multidisciplinary treatment pathways, consensus definitions of resectability, and patient selection;
• Long-term oncologic, functional, and quality-of-life outcomes following multimodal treatment;
• Emerging technologies, including artificial intelligence, radiomics, and imaging-based prediction models, for treatment planning and response assessment.

By consolidating contemporary evidence and highlighting emerging therapeutic and surgical strategies, this Research Topic seeks to advance multidisciplinary management of borderline resectable and locally advanced pancreatic cancer, while identifying future directions for research and clinical practice.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Pancreatic Ductal Adenocarcinoma, Neoadjuvant Chemotherapy, Borderline Resectable Pancreatic Cancer, Vascular Resection, Locally Advanced Pancreatic Cancer, Pancreaticoduodenectomy, Surgical Margin Status, Pancreatic Resection

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.