Surgical resection combined with systemic chemotherapy is the cornerstone of treatment for patients with localized pancreatic cancer. Upfront surgery is considered suboptimal in cases with extensive vascular involvement, which can be classified as either borderline resectable pancreatic cancer or locally advanced pancreatic cancer. In these patients, FOLFIRINOX or gemcitabine plus nab-paclitaxel chemotherapy is currently used as preoperative chemotherapy and is eventually combined with radiotherapy. Thus, more patients might reach 5-year overall survival. Patient selection for chemotherapy, radiotherapy and subsequent surgery is based on anatomical, biological and conditional parameters. Current guidelines and clinical practices vary considerably regarding preoperative chemotherapy and radiotherapy, response evaluation, and indications for surgery. In this Review, we provide an overview of the clinical evidence regarding disease staging, preoperative therapy, response evaluation and surgery in patients with borderline resectable pancreatic cancer or locally advanced pancreatic cancer. In addition, a clinical work-up is proposed based on the available evidence and guidelines. We identify knowledge gaps and outline a proposed research agenda.

手术切除联合全身化疗是局限性胰腺癌患者治疗的基石。对于广泛血管受累的病例，前期手术被认为是次优的，这种情况可分为边缘性可切除胰腺癌或局部晚期胰腺癌。在这些患者中，目前使用 FOLFIRINOX 或吉西他滨联合白蛋白结合型紫杉醇化疗作为术前化疗，并最终与放疗相结合。因此，更多的患者可能达到 5 年总生存期。化疗、放疗和后续手术的患者选择是基于解剖学、生物学和条件参数。目前的指南和临床实践在术前化疗和放疗、反应评估和手术指征方面存在很大差异。在这篇综述中，我们概述了关于交界性可切除胰腺癌或局部晚期胰腺癌患者的疾病分期、术前治疗、疗效评估和手术的临床证据。此外，根据现有证据和指南建议进行临床检查。我们确定知识差距并概述拟议的研究议程。