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BACKGROUND: The optimal treatment strategy for resectable pancreatic ductal adenocarcinoma (R-PDAC) remains controversial. In this study, we aimed to evaluate the impact of neoadjuvant chemotherapy (NAC) using gemcitabine plus nab-paclitaxel (GnP) or modified FOLFIRINOX (mFFX) compared with upfront surgery (UFS) in patients with R-PDAC. METHODS: This retrospective cohort study included 125 patients diagnosed with R-PDAC at a single institution between 2010 and 2022. The patients were divided into UFS (n = 57) and NAC (n = 68) groups. Survival outcomes, perioperative factors, and prognostic variables were analyzed. Subgroup analysis was performed based on high-risk features, defined as elevated carcinoembryonic antigen (CEA) levels >6 ng/mL and tumor size ≥25 mm. RESULTS: No significant differences were observed in overall survival (OS) and progression-free survival (PFS) between the entire UFS and NAC groups. However, in patients with high-risk features, NAC significantly improved OS compared with UFS (median survival 29.0 months vs. 10.6 months, respectively; P < 0.0001). NAC was associated with reduced intraoperative blood loss and a lower lymph node positivity rate without increasing postoperative morbidity or mortality. CONCLUSIONS: While NAC did not universally improve survival outcomes in R-PDAC, it significantly benefitted patients with poor prognostic indicators. These findings support a selective approach to NAC based on biological risk stratification rather than anatomical criteria alone. Future prospective studies are warranted to validate these observations and optimize individualized treatment strategies.
Research papers (academic journals)
