Surgery Alone May Cure Select Pancreatic Cancer Patients with Favorable Features: Study

Pancreatic cancer continues to be among the most lethal malignancies, with traditionally dismal long-term survival. Multimodal treatment involving surgery, chemotherapy, and irradiation is regarded as standard of care since pancreatic cancer tends to spread systemically. Yet, numerous patients decline or are not candidates for adjuvant therapy owing to frailty, complications, or patient preference. The role of surgery alone in outcome to survival in such cases has remained uncertain, with previous estimates postulating minimal gain over no therapy at all. Newer surgical techniques have enhanced perioperative morbidity and mortality, but remote recurrence remains the only factor to curtail long-term survival, with incidences of up to 85%.

This retrospective cohort analysis used data from the National Cancer Database in patients with resectable pancreatic cancer (clinical stage I-II) between 2010 and 2016. A total of 39,130 patients participated, of whom 2,876 were treated with no neoadjuvant or adjuvant therapy. The authors performed a propensity match of 471 patients who had upfront curative surgery and 471 patients with no treatment. Baseline characteristics were well matched afterward. Outcomes were measured by overall survival (OS), surgical margin status (R0 vs. non-R0), and lymph node status (node-negative vs. node-positive).

Results

• Analysis found that patients who were operated upon had a median OS of 14.09 months versus 6.34 months in the patients who were not treated at all.

• Notably, the advantage of surgery was largely observed in patients with clean surgical margins (R0), for whom the median OS was 17.87 months compared to 7.56 months in non-R0 patients.

• Lymph node status also had an effect, with patients having node-negative disease experiencing a median OS of 22.64 months and those with at least one positive node having a median OS of 12.65 months.

• Among the surgical group, 364 (77%) had R0 resection, and 197 (42%) were node-negative.

• None of the patients in the no-treatment arm survived to 5 years.

• These results show that although surgery alone is non-curative for most, it can confer a substantial survival benefit, especially when optimal surgical results are obtained.

This study concluded that surgery can profoundly prolong survival in patients with resectable pancreatic cancer, especially in those with clear margins and negative nodes. Although not curative for the majority, about 15% of patients can become long-term survivors with surgery alone, emphasizing its utility as a therapy when multimodal treatment is prohibitive.

Reference:

Anteby R, et al "Operation alone for resectable pancreatic adenocarcinoma: Should we operate if multimodal treatment is off the table?" J Am Coll Surg 2025; DOI: 10.1097/XCS.0000000000001464.