**Abbreviations**




final pathological diagnosis other than PaC [38], thus receiving a useless neoadjuvant treatment. In Golcher's study pathological diagnosis of PaC at biopsy has been rejected in 4.5% of resected patients (because of the finding of a distal choledochal adenocarcinoma and a

The use of different resectability classifications, different NADT protocols, and selective reporting in the past years makes the comparison of literature extremely tricky. Outcomes tend to be better outside an RCT context; literature is influencing our conduct, but strong evidences come only from well-designed randomized trials. The unanimous adoption of the International Association of Pancreatology's classification [3] and standardized protocols and trials might clarify the impact of neoadjuvant treatments on the survival of those patients. Assuming that patients are unresectable at diagnosis in the vast majority of cases; that even if they are suitable for NADT, more than 20% give up because of progression or toxicity; that barely an half is then resected; that, of those, up to 20% have positive margins; and that nor a negative resection margin nor a complete pathologic response shelters the patient from recur-

rence, we may say that nowadays PaC treatment desperately needs un upgrading.

Waiting for strong evidences, a reasonable behavior could be to resect all patients primarily resectable without any biologic worrisome feature (high CA19.9, high CEA, tumor >3 cm, positive nodes) and to offer all nonmetastatic patients neoadjuvant treatment in order to select those eligible for surgical exploration. Obviously, this has always to be done in the

duodenal adenocarcinoma) [58].

context of randomized controlled trials.

The authors have no acknowledgement or funding to declare.

The authors have no conflict of interest to declare.

**Acknowledgements**

**Conflict of interest**

**Abbreviations**

PaC Pancreatic cancer

ADT Adjuvant treatment BLR Borderline resectable

**8. Conclusions**

206 Advances in Pancreatic Cancer
