Modern japanese approach to pancreatic cancer

Principal clues to early diagnosis of pancreatic cancer including pancreatic duct dilation, diabetes, and intraductal papillary mucinous neoplasms are discussed, referring to Japanese contributions. The Japan Pancreas Society (JPS) has revised fourth edition of Clinical Guidelines for Management of Pancreatic Cancer, providing 51 clinical questionswith graded evidence-based recommendations in 2016, and diagnosis, chemotherapy, radiation therapy, surgical resection, adjuvant treatments, and supportive therapy are addressed. "Borderline resectable (BR)" pancreatic cancer is a new concept, and JPS makes two categories of BR pancreatic cancer such as involvement of only portal vein (BR-PV) and involvement of major artery (BR-A). Extended resection cannot be actively advocated in patients with pancreatic cancer in the present daily practice, because several prospective randomized trials did not confirm the survival benefit of extended resection compared to standard resection. The analysis using data of the JPS Pancreatic Cancer Registry indicates that the 5-year survival rate of patients after resection of pancreatic cancer has been significantly improved after the introduction of gemcitabine into Japan. More recently, a Japanese group has demonstrated that S-1 adjuvant chemotherapy is superior to gemcitabine. Recent great interest in Japan is to clarify the significance of neoadjuvant treatments in resectable and BR pancreatic cancer.