This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C). Anatomic factors include tumor contact with the superior mesenteric artery and/or celiac artery of less than 180° without showing stenosis or deformity, tumor contact with the common hepatic artery without showing tumor contact with the proper hepatic artery and/or celiac artery, and tumor contact with the superior mesenteric vein and/or portal vein including bilateral narrowing or occlusion without extending beyond the inferior border of the duodenum. Biological factors include potentially resectable disease based on anatomic criteria but with clinical findings suspicious for (but unproven) distant metastases or regional lymph nodes metastases diagnosed by biopsy or positron emission tomography-computed tomography. This also includes a serum carbohydrate antigen (CA) 19-9 level more than 500 units/ml. Conditional factors include the patients with potentially resectable disease based on anatomic and biologic criteria and with Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. The definition of BR-PDAC requires one or more positive dimensions (e.g. A, B, C, AB, AC, BC or ABC). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumor and vessels, but that biological and conditional dimensions are also important. The aim in presenting this consensus definition is also to highlight issues which remain controversial and require further research.

This paper is part of the international consensus guidelines on chronic pancreatitis, presenting for interventional endoscopy. An international working group with experts on interventional endoscopy evaluated 26 statements generated from evidence on 9 clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the level of evidence. To determine the level of agreement, a nine-point Likert scale was used for voting on the statements. Strong consensus was obtained for 15 statements relating to nine questions including the recommendation that endoscopic intervention should be offered to patients with persistent severe pain but not to those without pain. Endoscopic decompression of the pancreatic duct could be used for immediate pain relief, and then offered surgery if this fails or needs repeated endoscopy. Endoscopic drainage is preferred for portal-splenic vein thrombosis and pancreatic fistula. A plastic stent should be placed and replaced 2-3 months later after insertion. Endoscopic extraction is indicated for stone fragments remaining after ESWL. Interventional treatment should be performed for symptomatic/complicated pancreatic pseudocysts. Endoscopic treatment is recommended for bile duct obstruction and afterwards surgery if this fails or needs repeated endoscopy. Surgery may be offered if there is significant calcification and/or mass of the pancreatic head. Percutaneous endovascular treatment is preferred for hemosuccus pancreaticus. Surgical treatment is recommended for duodenal stenosis due to chronic pancreatitis. This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis.

The Japan Pancreas Society (JPS) published the fifth Japanese edition of the General Rules for the Study of Pancreatic Cancer in 2002, the same year that the Union Internationale Contre le Cancer (UICC) published its sixth edition. The JPS fifth edition had been revised, based on data from 18,629 cases of carcinoma of the pancreas registered by the JPS (1981-1996) with the goal of making the General Rules simple, easy to understand, and reliable for predicting outcome. The 2 classifications are compared by analyzing the data on 3979 resected patients with tubular adenocarcinoma of the pancreatic head registered by the JPS, focusing on the reliability of predicting outcome. In the extent of the primary tumor (T category), survival rates differed significantly among the 4 groups (T1, T2, T3, T4) in the JPS and UICC classifications. In the extent of lymph node metastasis (N category), survival rates differed significantly among the 4 groups (N0, N1, N2, N3) in the JPS classification and also did significantly between the 2 groups (N0, N1) in the UICC classification. In the stage grouping, however, 2 classifications differed considerably. More than half of the cases of UICC stage II are equivalent to JPS stage IV. Comparison of survival curves according to stage reveals that stratification is much better in the JPS classification than in the UICC classification. These results indicate that the JPS classification is more reliable for predicting outcome as compared with the UICC classification.