NICE guideline 8: Managing resectable (operable) and borderline resectable pancreatic cancer

Read all the NICE guidelines for pancreatic cancer

Explaining the NICE guidelines for diagnosing and managing pancreatic cancer
NICE guideline 1: Diagnosing pancreatic cancer
NICE guideline 2: Specialist pancreatic multidisciplinary teams
NICE guideline 3: Working out how far pancreatic cancer has spread (staging)
NICE guideline 4: Emotional (psychological) support
NICE guideline 5: Managing pain
NICE guideline 6: Managing diet and nutrition
NICE guideline 7: Relieving a blocked bile duct or duodenum
NICE guideline 8: Managing resectable (operable) and borderline resectable pancreatic cancer
NICE guideline 9: Managing pancreatic cancer that can’t be removed with surgery (inoperable or unresectable cancer)

Resectable (operable) cancer is cancer that can be removed by surgery.

Sometimes the cancer may grow very close to the major blood vessels near the pancreas. This is called borderline resectable pancreatic cancer. It may be possible to remove the cancer, but it depends which blood vessels are affected and how far the cancer has grown.

The NICE guidelines were published in 2018. Since then, there have been some changes in how chemotherapy is used. We have provided some information here, and suggest you follow the links for more up to date information.

Treatment before surgery (neoadjuvant treatment)

8.1 If you have borderline resectable pancreatic cancer, chemotherapy before surgery should be considered as part of a clinical trial.

If you have borderline reseactable, you may be offered chemotherapy, sometimes followed by chemotherapy with radiotherapy (chemoradiotherapy). This can sometimes shrink the cancer enough to make surgery possible.

8.2 If you have operable pancreatic cancer, chemotherapy before surgery should only be considered as part of a clinical trial.

Surgery

8.3 If you are having surgery to remove cancer in the head of the pancreas, your doctor should consider pylorus-preserving surgery, as long as it removes all the cancer.

Pylorus-preserving surgery doesn’t remove part of the stomach or the stomach valve (the pylorus).

Read more about surgery to remove pancreatic cancer.

Chemotherapy after surgery (adjuvant treatment)

8.4 You should be given time to recover from surgery before starting chemotherapy. Chemotherapy should be started as soon as you are well enough to cope with six rounds of chemotherapy (six cycles).

8.5 You may be offered gemcitabine chemotherapy with capecitabine (GemCap) following surgery, once you have recovered from the surgery.

You may be offered FOLFIRINOX rather than GemCap.

8.6 If you are not well enough for a combination of chemotherapy drugs like FOLFIRINOX or GemCap following surgery, your doctor should consider gemcitabine alone.

This may have fewer side effects, but it may still help you live longer.

Read more about chemotherapy after surgery.

Follow-up after surgery to remove pancreatic cancer

8.7 You should have regular check-ups with the specialist team after surgery, to manage any side effects or problems from the surgery.

8.8 If you get new, unexplained or ongoing symptoms following treatment, these should be investigated by the specialist team. You should be offered services to support you.