{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:45:58Z","timestamp":1774957558001,"version":"3.50.1"},"reference-count":74,"publisher":"Harborside Press, LLC","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Upfront resectable pancreatic ductal adenocarcinoma (PDAC) is defined by the NCCN as disease with \u2264180\u00b0 portomesenteric vein (PMV) abutment. However, the clinical significance of PMV abutment in this cohort remains unexplored, and we sought to investigate its impact.\n                    <jats:bold>Methods:<\/jats:bold>\n                    This multi-institutional study included patients who underwent pancreatoduodenectomy (PD) for upfront resectable PDAC from 2002 to 2023. Patients with PDAC with \u2264180\u00b0 PMV abutment were compared with those without. Overall survival (OS) was compared and stratified based on whether patients underwent upfront surgery or neoadjuvant therapy (NAT).\n                    <jats:bold>Results:<\/jats:bold>\n                    Among 1,446 patients included, 521 (36.0%) had PMV abutment. Median OS for patients with PMV abutment was 28.8 months compared with 31.2 months for those without (\n                    <jats:italic>P<\/jats:italic>\n                    =.17). In a stratified analysis of patients who underwent upfront surgery, patients with PMV abutment had worse OS (19.2 vs 27.6 months;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.05) and lower R0 resection rates (63.1% vs 87.2%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.05) compared with those without. However, in patients who underwent NAT, this difference in R0 resection rate was not observed (91.4% vs 94.0%, respectively;\n                    <jats:italic>P<\/jats:italic>\n                    =.27). Furthermore, there was no significant difference in median OS with NAT (42.5 vs 51.6 months, respectively;\n                    <jats:italic>P<\/jats:italic>\n                    =.48).\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    In this largest cohort to date of patients with upfront resectable PDAC, PMV abutment was associated with worse OS compared with no PMV abutment when an upfront resection strategy was used. The use of NAT in patients with PMV abutment mitigated this survival difference with increased R0 resection rates. These findings suggest that patients with upfront resectable PDAC with PMV abutment benefit from a NAT approach for optimal survival outcomes, and that the current criteria guidelines need to be redefined.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2025.7097","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T13:46:30Z","timestamp":1770644790000},"page":"27-33","source":"Crossref","is-referenced-by-count":1,"title":["Redefining Upfront Resectable Pancreatic Ductal Adenocarcinoma: Should Vein Abutment Matter?"],"prefix":"10.6004","volume":"24","author":[{"given":"Po Hong","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelius A.","family":"Thiels","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Poruk","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Jacksonville, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard Max","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoe Yan","family":"Hor","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melody Pi Yin","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle R.","family":"Huyser","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chee-Chee","family":"Stucky","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabil","family":"Wasif","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Bold","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory L.","family":"Smoot","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick P.","family":"Starlinger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne G.","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Kendrick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Stauffer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Jacksonville, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark J.","family":"Truty","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi Ven","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"B1","series-title":"CA Cancer J Clin","first-page":"17","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel RL","year":"2023","unstructured":"Siegel RL, Miller KD, Wagle NS,  Cancer statistics, 2023. 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