Long‐Term Outcomes of Neoadjuvant Therapy Versus Upfront Surgery for Resectable Pancreatic Ductal Adenocarcinoma

ABSTRACT Introduction This study aimed to compare the long‐term effects of neoadjuvant therapy and upfront surgery on overall survival (OS) and progression‐free survival (PFS) in patients with resectable pancreatic ductal adenocarcinoma (PDAC). Methods We retrospectively analyzed 202 patients, including 167 who had upfront surgery and 35 who received neoadjuvant therapy followed by surgery. Surgical outcomes and survival rates were compared using propensity score matching to minimize selection bias. Results Neoadjuvant therapy showed significantly longer 75% OS (72.7 months vs. 28.3 months, p = 0.032) and PFS (29.6 months vs. 13.2 months, p