Evidence map›Paper›PMID 40440879›Full record

SynthesisThe Journal of surgical research2025

Neoadjuvant Therapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: A Systemic Review and Meta-Analysis.

Chandler A Annesi, Michelle Holland, M Chandler McLeod, Sushanth Reddy, J Bart Rose, Vikas Dudeja, Martin J Heslin, Annabelle L Fonseca

Erratum issuedAbstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Journal of surgical research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Chandler A AnnesiDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Michelle HollandDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
M Chandler McLeodDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Sushanth ReddyDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
J Bart RoseDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Vikas DudejaDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Martin J HeslinDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Annabelle L FonsecaDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: afonseca@uabmc.edu.

Funding

Surgical Oncology Research Training ProgramT32CA229102 · NCI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI HERBERT CHEN · 2018 to 2026
$3.2M
Using Modifiable Factors to Predict Risk of non-Guideline Concordant Treatment in Foregut Cancers: A Novel Implementation Science-based approachK23MD018383 · NIMHD · UNIVERSITY OF SOUTH ALABAMA · PI Annabelle L Fonseca · 2023 to 2026
$647k
NCI NIH HHS T32 CA229102NIMHD NIH HHS K23 MD018383
6 · The paper itself

Abstract

introductionIt is accepted that patients with pancreatic cancer are best treated by a combination of surgical resection and systemic chemotherapy; the optimal sequence remains debated. There are ongoing trials on survival benefit of neoadjuvant therapy (NAT) compared to upfront surgery (UFS) in patients with resectable and borderline resectable pancreatic cancer; new and updated data must be analyzed for continued understanding of results.

methodsA search of multiple databases was performed for randomized controlled trials (RCTs) comparing NAT with UFS for resectable and borderline resectable pancreatic cancer. The systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was overall survival (OS) by intention-to-treat; subgroup analysis was also performed for resectable disease only. Meta-analyses were completed using random-effects models.

resultsThere were 13,406 records screened for inclusion; 51 were retrieved for further review; 34 were assessed for eligibility. Ten RCTs were included with 1340 patients split almost equally between NAT and UFS. Gemcitabine-based NAT was used in all but two RCTs. There was a significant improvement in median OS for NAT compared to UFS (hazard ratio 0.78, 95% confidence interval 0.61-0.99; P = 0.04; I

conclusionsIn this meta-analysis of prospective RCTs assuming intention-to-treat, NAT was associated with improvement in OS relative to UFS in patients with resectable and borderline resectable pancreatic cancer. Given the heterogeneity of the NAT regimens studied in this meta-analysis and recruitment challenges, additional analyses are warranted to confirm these findings and to determine the optimal sequencing of treatment modalities.

Indexed as

Neoadjuvant TherapyPancreatectomyPancreatic NeoplasmsChemotherapy, AdjuvantHumansRandomized Controlled Trials as TopicTreatment OutcomeBorderline resectableMeta-analysisNeoadjuvant therapyPancreatic cancerResectableSystematic reviewUpfront surgery

Identifiers

PMID40440879
PMCPMC12324811

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.