Salvage neoadjuvant strategy for unexpected intraoperative locally advanced pancreatic cancer

Background: Resection is the main determinant of curative intent treatment for pancreatic adenocarcinoma. In non-metastasized pancreatic adenocarcinoma, resection is limited by local tumor extent. To improve R0- resections neoadjuvant treatment is recommended for borderline resectable tumors. Locally advanced tumors can be converted to potentially resectable disease using neoadjuvant therapy. In case of intra-operative diagnosis of unexpected advanced or irresectable disease, the surgeon can choose between 2 strategies: to proceed with the resection augmenting the risk of an R1/2-resection or abort the procedure and try to convert the patient with a “salvage” neoadjuvant strategy. In this case series we present our experience with this salvage neoadjuvant strategy.