©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2025; 16(9): 108955
Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.108955
Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.108955
Neoadjuvant treatment in resectable pancreatic cancer: Why is upfront surgery so hard to be beaten?
Pedro Luiz Serrano Uson Junior, Center for Personalized Medicine, Hospital Israelita Albert Einstein, São Paulo 05651901, Brazil
Kunal C Kadakia, Department of Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, United States
Raphael L C Araujo, Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
Raphael L C Araujo, Department of Surgery, Hepato-pancreato-biliary Service, Carolinas Medical Center, Atrium Health, Charlotte, NC 28204, United States
Author contributions: Uson Junior PLS, Kadakia KC, and Araujo RLC contributed to the study conception, data preparation, data interpretation, and critical writing.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Raphael L C Araujo, FACS, MD, PhD, Adjunct Professor, Department of Surgery, Universidade Federal de São Paulo, R. Napoleão de Barros, 715, São Paulo 04024-002, Brazil. raphael.l.c.araujo@gmail.com
Received: April 27, 2025
Revised: May 23, 2025
Accepted: August 12, 2025
Published online: September 24, 2025
Processing time: 149 Days and 20.9 Hours
Revised: May 23, 2025
Accepted: August 12, 2025
Published online: September 24, 2025
Processing time: 149 Days and 20.9 Hours
Core Tip
Core Tip: Upfront surgery remains essential for patients with truly resectable tumors since surgery followed by adjuvant therapy is evidence-based and should not be abandoned. Moreover, current neoadjuvant treatment for resectable lesions with FOLFIRINOX is insufficient due to poor survival outcomes. Better systemic approaches are needed, and germline testing and precision medicine hold promise but are actionable in only a minority of cases, molecular subtyping should be incorporated into future trial designs.