{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:38:01Z","timestamp":1747147081893,"version":"3.40.5"},"reference-count":40,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005301","name":"American College of Surgeons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005301","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Although surgical resection is necessary, it is not sufficient for long\u2010term survival in pancreatic ductal adenocarcinoma (PDAC). We sought to evaluate survival after up\u2010front surgery (UFS) in anatomically resectable PDAC in the context of three critical factors: (A) margin status; (B) CA19\u20109; and (C) receipt of adjuvant chemotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The National Cancer Data Base (2010\u20132015) was reviewed for clinically resectable (stage 0\/I\/II) PDAC patients. Surgical margins, pre\u2010operative CA19\u20109, and receipt of adjuvant chemotherapy were evaluated. Patient overall survival was stratified based on these factors and their respective combinations. Outcomes after UFS were compared to equivalently staged patients after neoadjuvant chemotherapy on an intention\u2010to\u2010treat (ITT) basis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve thousand and eighty\u2010nine patients were included (<jats:italic>n\u00a0<\/jats:italic>=\u00a09197 UFS, <jats:italic>n<\/jats:italic>\u00a0=\u00a02892 ITT neoadjuvant). In the UFS cohort, only 20.4% had all three factors (median OS\u00a0=\u00a031.2\u00a0months). Nearly 1\/3rd (32.7%) of UFS patients had none or only one factor with concomitant worst survival (median OS\u00a0=\u00a014.7\u00a0months). Survival after UFS decreased with each failing factor (two factors: 23\u00a0months, one factor: 15.5\u00a0months, no factors: 7.9\u00a0months) and this persisted after adjustment. Overall survival was superior in the ITT\u2010neoadjuvant cohort (27.9 vs. 22\u00a0months) to UFS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the perceived benefit of UFS, only 1\u2010in\u20105 UFS patients actually realize maximal survival when known factors highly associated with outcomes are assessed. Patients are proportionally more likely to do worst, rather than best after UFS treatment. Similarly staged patients undergoing ITT\u2010neoadjuvant therapy achieve survival superior to the majority of UFS patients. Patients and providers should be aware of the false perception of \u2018optimal\u2019 survival benefit with UFS in anatomically resectable PDAC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.4144","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T08:10:06Z","timestamp":1626855006000},"page":"5925-5935","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Perception versus reality: A National Cohort Analysis of the surgery\u2010first approach for resectable pancreatic cancer"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4142-4905","authenticated-orcid":false,"given":"John R.","family":"Bergquist","sequence":"first","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Stanford University Stanford, Palo Alto California USA"},{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo Clinic Rochester Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3654-8601","authenticated-orcid":false,"given":"Cornelius A.","family":"Thiels","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo Clinic Rochester Rochester Minnesota USA"},{"name":"Department of Surgery Division of Surgical Oncology Memorial Sloan\u2010Kettering Cancer Center New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Shubert","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo Clinic Rochester Rochester Minnesota USA"},{"name":"Department of Surgery Division of Hepatopancreatobiliary Surgery Johns Hopkins University Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommy","family":"Ivanics","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo Clinic Rochester Rochester Minnesota USA"},{"name":"Department of Surgery Henry Ford Medical Center Detroit Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth B.","family":"Habermann","sequence":"additional","affiliation":[{"name":"Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santhi S.","family":"Vege","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester, Department of Medicine, Division of Gastroenterology Pancreatology Section Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis E.","family":"Grotz","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo Clinic Rochester Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean P.","family":"Cleary","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo Clinic Rochester Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory L.","family":"Smoot","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Mayo 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