Actual Five-year Survival After Neoadjuvant Therapy and Resection for Localized Pancreatic Ductal Adenocarcinoma
In brief
One in three patients reach five-year survival after neoadjuvant therapy and surgery for localized pancreatic cancer
In a cohort of 660 patients treated at two high-volume centers, 34.5% were alive at five years post-resection, with most remaining disease-free. Recurrence was common (74%) and usually occurred within the first year, while patients who stayed recurrence-free for one or two years had 62% and 82% chances of five-year survival respectively. Early systemic failure drives outcomes, highlighting the need for better peri-operative control.
- Journal
- Annals of surgery (Q1)
- Published
- 10 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Federico De Stefano, Giulio Belfiori, Nathaniel F Wu, Jill N Allen, Laura Cerri Crn, Jeffrey W Clark, et al.
- PMID
- 42717278
- DOI
- 10.1097/SLA.0000000000007214
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 15 September 2026): Neoadjuvant therapy and resection outcomes in PDAC
Abstract
OBJECTIVE: To determine actual 5-year survival after neoadjuvant therapy and resection for pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Long-term outcomes after neoadjuvant therapy and resection for PDAC remain poorly defined, as current knowledge largely relies on actuarial estimates. METHODS: Retrospective cohort study of consecutive patients who underwent neoadjuvant therapy followed by curative-intent pancreatectomy for localized PDAC at 2 high-volume centers between January 2015 and February 2021. Only patients with complete follow-up (death or ≥5 y) were included. The primary endpoint was actual 5-year survival from surgery. RESULTS: Among 660 patients, actual 5-year survival was 34.5%. Recurrence occurred in 74.1% and was predominantly early, with nearly two-thirds of recurrences among patients who did not achieve 5-year survival occurring within 1 year after surgery. Long-term survivors had lower recurrence rates (92/228, 40.4%) and more commonly developed delayed (>2 y), locoregional, or pulmonary recurrence. The probability of achieving 5-year survival increased to 62.0% (95% CI: 56-67) and 81.9% (95% CI: 76-86) among patients who remained recurrence-free at 1 and 2 years, respectively. Actual 5-year survival was 42.5%, 29.0%, and 17.5% in patients with resectable, borderline-resectable, and locally advanced disease at diagnosis, respectively. Independent predictors of long-term survival included low comorbidity burden, baseline CA19-9 <200 U/mL, resectable disease at diagnosis, ypT0-1 stage, and R0 resection. CONCLUSIONS: Over one-third of patients undergoing neoadjuvant therapy and resection for localized PDAC were alive at 5 years, and most remained disease-free. Long-term outcomes were primarily determined by early systemic failure, whereas delayed oligometastatic recurrence identified a subgroup with prolonged survival.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.