Oncological Outcomes After Margin-Negative (R0) Resection in Borderline Resectable Pancreatic Adenocarcinoma: Upfront Surgery Versus Neoadjuvant Treatment-A Contemporary Review.
[BACKGROUND] Achieving a margin-negative (R0) resection in borderline resectable pancreatic cancer (BRPC) is a critical prognostic determinant.
APA
Wiboonkhwan NA (2026). Oncological Outcomes After Margin-Negative (R0) Resection in Borderline Resectable Pancreatic Adenocarcinoma: Upfront Surgery Versus Neoadjuvant Treatment-A Contemporary Review.. ANZ journal of surgery. https://doi.org/10.1111/ans.70575
MLA
Wiboonkhwan NA. "Oncological Outcomes After Margin-Negative (R0) Resection in Borderline Resectable Pancreatic Adenocarcinoma: Upfront Surgery Versus Neoadjuvant Treatment-A Contemporary Review.." ANZ journal of surgery, 2026.
PMID
41804204
Abstract
[BACKGROUND] Achieving a margin-negative (R0) resection in borderline resectable pancreatic cancer (BRPC) is a critical prognostic determinant. The optimal clinical strategy-neoadjuvant therapy (NAT) versus upfront surgery (UFS)-remains a key clinical question.
[METHODS] This narrative review synthesized contemporary evidence from studies published between 2009 and 2025, encompassing a total of 5598 patients with BRPC. The analysis compared oncological outcomes between NAT and UFS, specifically focusing on resection rates, R0 resection frequency, and median overall survival (OS). Mixed-cohort studies lacking BRPC subgroup analysis were excluded.
[RESULTS] Evidence from both comparative and single-arm studies indicated that the majority of cohorts achieved significantly higher R0 resection rates and improved median OS following NAT. Resection rates after NAT ranged from 29% to 90%, whereas UFS cohorts reported rates between 62% and 92%. Although resection was more frequent in UFS groups, NAT cohorts demonstrated superior oncological margins; R0 rates in NAT groups ranged from 23% to 100% compared to 14% to 90% in UFS groups. This translated into a survival benefit, with NAT groups achieving a median OS of 11.0 to 43.9 months versus 11.6 to 27.8 months for UFS. NAT also facilitated superior pathological downstaging and reduced lymph node positivity.
[CONCLUSION] Neoadjuvant therapy, utilizing potent multi-agent regimens, significantly improves R0 resection rates and overall survival in BRPC and is increasingly recognized as the preferred clinical strategy. Currently, this survival benefit is not clearly established for patients with upfront resectable disease.
[METHODS] This narrative review synthesized contemporary evidence from studies published between 2009 and 2025, encompassing a total of 5598 patients with BRPC. The analysis compared oncological outcomes between NAT and UFS, specifically focusing on resection rates, R0 resection frequency, and median overall survival (OS). Mixed-cohort studies lacking BRPC subgroup analysis were excluded.
[RESULTS] Evidence from both comparative and single-arm studies indicated that the majority of cohorts achieved significantly higher R0 resection rates and improved median OS following NAT. Resection rates after NAT ranged from 29% to 90%, whereas UFS cohorts reported rates between 62% and 92%. Although resection was more frequent in UFS groups, NAT cohorts demonstrated superior oncological margins; R0 rates in NAT groups ranged from 23% to 100% compared to 14% to 90% in UFS groups. This translated into a survival benefit, with NAT groups achieving a median OS of 11.0 to 43.9 months versus 11.6 to 27.8 months for UFS. NAT also facilitated superior pathological downstaging and reduced lymph node positivity.
[CONCLUSION] Neoadjuvant therapy, utilizing potent multi-agent regimens, significantly improves R0 resection rates and overall survival in BRPC and is increasingly recognized as the preferred clinical strategy. Currently, this survival benefit is not clearly established for patients with upfront resectable disease.