Survival Benefit of Surgery versus Oncology-Only Therapy in Artery-Involving Borderline Resectable and Locally Advanced Pancreatic Cancer
Abstract
Background: Modern chemotherapy has redefined resectability of pancreatic ductal adenocarcinoma (PDAC), prioritizing tumor biology over anatomy. However, comparative outcomes of surgery versus continued oncologic therapy (COT) in borderline resectable (BR) or locally advanced (LA) PDAC remain unclear. This study addresses this gap.
Patients and methods: This retrospective, international, multicenter cohort study included patients with BR/LA-PDAC treated with neoadjuvant or primary chemotherapy between 2012 and 2024. All met guideline-based criteria for potential resection on the basis of anatomy, biology, and performance status. Treatment allocation (surgery versus COT) was based on institutional practice or surgeon preference, reflecting real-world decision-making. The primary endpoint was overall survival (OS), analyzed using unadjusted comparison, propensity score matching (PSM), and entropy balancing.
