Objective:

To compare short- and long-term outcomes in patients with pancreatic cancer and suspected venous involvement who underwent upfront surgery (US) or neoadjuvant therapy (NAT) followed by surgery.

Approach:

• Study Design: Multicenter retrospective cohort study of patients treated from 2007 to 2017. Eligible diagnoses included pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous neoplasm.
• Patient Selection: Patients who underwent surgery were grouped according to whether they received US or NAT before surgery. Patients with arterial involvement, distant metastases, or no oncological follow-up were excluded.
• Outcome Measures: The study assessed morbidity and mortality within 30 and 90 days, as well as overall and disease-free survival.
• Statistical Analysis: Analyses included Student’s *t*-test, chi-square tests, Kaplan–Meier estimates, and Cox regression models.

Key Findings:

• The study included 690 patients in the US group and 361 in the NAT group.
• Patients in the US group were older and less likely to be smokers than those in the NAT group.
• Complications and reoperations were more frequent in the US group.
• The US group had less favorable pathological findings, including higher rates of advanced tumors and R1 resections.

Interpretation:

The findings suggest that NAT may be associated with more favorable pathological outcomes and fewer postoperative complications than US in patients with pancreatic cancer and suspected venous involvement. However, because the study was retrospective and included only patients who ultimately underwent surgery, the results do not establish that NAT improves survival or that the treatment strategy caused the observed differences. Treatment decisions should therefore be individualized.

Limitations:

• The retrospective design may be subject to selection bias and does not establish that treatment strategy caused the observed differences.
• Data were collected from existing patient records, which may have been incomplete.

Conclusion:

Among patients with pancreatic cancer and suspected venous involvement who underwent surgery, NAT was associated with more favorable pathological outcomes and fewer postoperative complications than US. These findings do not demonstrate a survival benefit or establish causation; prospective studies are needed to clarify the optimal treatment strategy.

Sources:

• Upfront surgery vs. neoadjuvant therapy in pancreatic cancer with venous involvement: a multicenter retrospective analysis