Figure 1.

Treatment algorithm for PDAC patients using “ABC method” (A—anatomical resectabi- lity, B—biological resectability and C—clinical conditions). All PDAC patients should initiate systemic treatment apart from anatomically resectable PDAC without high-risk biological factors (absence of B factors) and fitness for surgery (absence of C factor), as demonstrated in the figure. In all cases, there are no rigid cut-offs for any high-risk aggressive features; therefore, these are left as considerations for the treating oncologists/surgeons. Note that before any systemic chemotherapy, biopsy for histological characterization is mandatory. High-risk biological features include suspicious hepatic or pulmonary lesions, the presence of positive lymph nodes (histologically proven or based on positivity of PET-FDG scan), large pancreatic primary tumors with dimension superior to 2–3 cm, elevated baseline level tumor biomarker CA 19-9 and several clinical characteristics such as celiac-type pain or significant weight loss (≥10% of body weight).