Pancreatic ductal adenocarcinoma (PDAC) remains a devastating illness that takes the lives of virtually all diagnosed. The 5-year survival for patients who have undergone surgical resection with curative intent remains less than 20%. Considerable effort has thus been expended into the development of adjuncts to surgical management, including both adjuvant and neoadjuvant therapies. The importance of a complete or R0 resection has been documented in terms of its benefit on overall survival. Hence, the determination of resectability is paramount. Improved diagnostics and advancements in surgical techniques have led to the emergence of borderline resectable tumors, a spectrum of disease falling between overtly resectable and locally advanced, unresectable PDACs. Uniformly defining this patient population is essential, both to optimally care for more patients and for the development of stage-specific, novel clinical trials. A multimodal approach to patient care done in high-volume centers ensures that physicians with the most expertise will be caring for this complex patient population.