Evidence map›Paper›PMID 40954390›Full record

ArticleAnnals of surgical oncology2025

Survival Benefit of Surgery versus Oncology-Only Therapy in Artery-Involving Borderline Resectable and Locally Advanced Pancreatic Cancer.

Niccolò Napoli, Allegra Ripolli, Emanuele F Kauffmann, Michael Ginesini, Riccardo Casadei, Roberto Coppola, Vyacheslav Egorov, Yuichi Nagakawa, Elena Rangelova, Emilio Vicente and 2 more

Abstract readMulticenter StudyComparative Study
PubMed Publisher
In one paragraph

Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing 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

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Niccolò NapoliDivision of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Allegra RipolliDivision of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Emanuele F KauffmannDivision of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Michael GinesiniDivision of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Riccardo CasadeiAlma Mater Studiorum, University of Bologna, IRCCS, AOUBO, Bologna, Italy.
Roberto CoppolaFondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Vyacheslav EgorovDepartment for Surgical Oncology and HPB Surgery, Ilyinskaya Hospital, Moscow, Russia.
Yuichi NagakawaDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Elena RangelovaDepartment of Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
Emilio VicenteGemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
Ugo BoggiDivision of General and Transplant Surgery, University of Pisa, Pisa, Italy. u.boggi@med.unipi.it.
and the Rediscover Study Group members

Funding

Fondazione Pisa REDISCOVER project
6 · The paper itself

Abstract

backgroundModern chemotherapy has redefined resectability of pancreatic ductal adenocarcinoma (PDAC), prioritizing tumor biology over anatomy. However, comparative outcomes of surgery versus continued oncologic therapy (COT) in borderline resectable (BR) or locally advanced (LA) PDAC remain unclear. This study addresses this gap. PATIENTS AND

methodsThis retrospective, international, multicenter cohort study included patients with BR/LA-PDAC treated with neoadjuvant or primary chemotherapy between 2012 and 2024. All met guideline-based criteria for potential resection on the basis of anatomy, biology, and performance status. Treatment allocation (surgery versus COT) was based on institutional practice or surgeon preference, reflecting real-world decision-making. The primary endpoint was overall survival (OS), analyzed using unadjusted comparison, propensity score matching (PSM), and entropy balancing.

resultsA total of 312 patients were included: 158 underwent resection and 154 received COT. Median OS was 39.0 months (IQR 14.3-42.6 months) with resection versus 16.7 months (IQR 8.8-22.5 months) with COT (p < 0.0001). After PSM (75 pairs), OS remained significantly longer with resection (42.6 months, IQR 12.9-42.1 months) versus COT (18.6 months, IQR 9.4-23.9 months; p < 0.0001). In the LA-PDAC subgroup, OS was 42.6 months (IQR 23.2-NA months) with resection versus 18.6 months (IQR 11.8-25.6 months; p < 0.0001) with COT. On multivariable analysis, resection (HR 0.34, 95% CI 0.21-0.54; p < 0.0001) and CA 19-9 (HR 1.0001; p = 0.0297) were independently associated with OS. Entropy-weighted models confirmed these findings. The survival benefit persisted when postoperative deaths were included.

conclusionsIn patients with BR/LA-PDAC with favorable response to chemotherapy, surgical resection significantly improves survival compared with COT.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsCarcinoma, Pancreatic DuctalNeoadjuvant TherapyPancreatectomyPancreatic NeoplasmsAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisRetrospective StudiesSurvival RateBorderline resectable pancreatic ductal adenocarcinomaContinued oncologic treatmentLocally advanced pancreatic ductal adenocarcinomaNeoadjuvant chemotherapyPrimary chemotherapyResectionSurvival

Identifiers

PMID40954390

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.