REDISCOVER guidelines for borderline-resectable and locally advanced pancreatic cancer: management algorithm, unanswered questions, and future perspectives
Authors: Boggi Ugo , Kauffmann Emanuele F. , Napoli Niccolò , Barreto S. George , Besselink Marc G. , Fusai Giuseppe K. , Hackert Thilo , Hilal Mohammad Abu , Marchegiani Giovanni , Salvia Roberto , Shrikhande Shailesh V. , Truty Mark , Werner Jens , Wolfgang Christopher , Bannone Elisa , Capretti Giovanni , Cattelani Alice , Coppola Alessandro , Cucchetti Alessandro , De Sio Davide , Di Dato Armando , Di Meo Giovanna , Fiorillo Claudio , Gianfaldoni Cesare , Ginesini Michael , Hidalgo Salinas Camila , Lai Quirino , Miccoli Mario , Montorsi Roberto , Pagnanelli Michele , Poli Andrea , Ricci Claudio , Sucameli Francesco , Tamburrino Domenico , Viti Virginia , Cameron John , Clavien Pierre-Alain , Asbun Horacio J. ,   the REDISCOVER guidelines group, Addeo Pietro F. , Alfieri Sergio , Bachellier Philippe , Baiocchi Gianluca , Balzano Gianpaolo , Barbarello Linda , Brolese Alberto , Busquets Juli , Butturini Giovanni , Caniglia Fabio , Caputo Damiano , Casadei Riccardo , Chunhua Xi , Colangelo Ettore , Coratti Andrea , Costa Francesca , Crafa Francesco , Valle Raffaele Dalla , De Carlis Luciano , de Wilde Roeland F , Del Chiaro Marco , Di Benedetto Fabrizio , Di Sebastiano Pierluigi , Dokmak Safi , Hogg Melissa , Egorov Vyacheslav I. , Ercolani Giorgio , Ettorre Giuseppe Maria , Falconi Massimo , Ferrari Giovanni , Ferrero Alessandro , Filauro Marco , Giardino Alessandro , Grazi Gian Luca , Gruttadauria Salvatore , Izbicki Jakob R. , Jovine Elio , Katz Matthew , Keck Tobias , Khatkov Igor , Kiguchi Gozo , Kooby David , Lang Hauke , Lombardo Carlo , Malleo Giuseppe , Massani Marco , Mazzaferro Vincenzo , Memeo Riccardo , Miao Yi , Mishima Kohei , Molino Carlo , Nagakawa Yuichi , Nakamura Masafumi , Nardo Bruno , Panaro Fabrizio , Pasquali Claudio , Perrone Vittorio , Rangelova Elena , Riu Long , Romagnoli Renato , Romito Raffaele , Rosso Edoardo , Schulick Richard , Siriwardena Ajith K. , Spampinato Marcello , Strobel Oliver , Testini Mario , Troisi Roberto , Uzunoglo Faik G. , Valente Roberto , Veneroni Luigi , Zerbi Alessandro , Vicente Emilio , Vistoli Fabio , Vivarelli Marco , Wakabayashi Go , Zanus Giacomo , Zureikat Amer , Zyromski Nicholas J. , Coppola Roberto , D’Andrea Vito , Davide José , Dervenis Christos , Frigerio Isabella , Konlon Kevin C. , Michelassi Fabrizio , Montorsi Marco , Nealon William , Portolani Nazario , Silva Donzília Sousa , Bozzi Giuseppe , Ferrari Viviana , Trivella Maria G. , Boraschi Piero , Campani Daniela , Cappelli Carla , Cioni Roberto , Dominici Massimo , Esposito Irene , Gambacorta Maria A. , Marciano Emanuele , Masi Gianluca , Morganti Alessio , Mutignani Massimiliano , Neri Emanuele , Paiar Fabiola , Reni Michele , Rotondo Maria Isabella , Silvestris Nicola , Tortora Giampaolo , Vasile Enrico , Volterran Duccio 
Published: April 2024

The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC to align with modern treatment strategies and to solve some contradictions within the current definition, such as grouping "difficult" and "impossible" to resect tumors together. Furthermore, the REDISCOVER guidelines highlight several areas requiring urgent research. These include the resection of the superior mesenteric artery, the management strategies for patients with LA-PDAC who are fit for surgery but unable to receive multi-agent neoadjuvant chemotherapy, the approach to patients with LA-PDAC who are fit for surgery but demonstrate high serum Ca 19.9 levels even after neoadjuvant treatment, and the optimal timing and number of chemotherapy cycles prior to surgery. Additionally, the role of primary chemoradiotherapy versus chemotherapy alone in LA-PDAC, the timing of surgical resection post-neoadjuvant/primary chemoradiotherapy, the efficacy of ablation therapies, and the management of oligometastasis in patients with LA-PDAC warrant investigation. Given the limited evidence for many issues, refining existing management strategies is imperative. The establishment of the REDISCOVER registry (https://rediscover.unipi.it/) offers promise of a unified research platform to advance understanding and improve the management of BR-PDAC and LA-PDAC.