SMAD4 and familial pancreatic carcinoma: Whereas further work is needed, our results, combined with those previously reported in the literature, suggest that patients with borderline resectable pancreatic cancers and SMAD4 gene inactivation might be spared the risk of surgery because their cancer is more likely to metastasize, whereas patients with borderline resectable pancreatic cancers and intact SMAD4 may benefit from the local control provided by neoadjuvant therapy and surgical resection.’ [171]