Background: Neoadjuvant therapy (NAT)’s potential impact on the long-term overall survival of patients with resectable pancreatic cancer (RPC) remains uncertain. This study aims to evaluate the efficacy and safety of NAT compared with upfront surgery (US) in patients with RPC. Methods: From January 1, 2009 to October 1, 2024, we comprehensively searched PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify randomized controlled trials comparing NAT with US for RPC. The primary outcomes were the relative risk (RR) of R0 resection rates (defined as negative surgical margins ≤1 mm in postoperative pathology) and major complications (including pancreatic fistula, biliary fistula, gastroparesis, hemorrhage, intra-abdominal infection, etc). Additionally, we extracted and reconstructed patient-level survival data from Kaplan–Meier curves to analyze the hazard ratio of median survival time between groups. Results: A total of 6 randomized controlled trials involving 670 patients were included. NAT significantly improved the R0 resection rate compared with US (RR = 1.41, I 2 = 0%, P < .00001). Four studies reported major postoperative complications, showing a trend toward reduced incidence with NAT (RR = 0.82, I 2 = 59%, P = .54), though heterogeneity was high and results were not statistically significant. Survival data from 5 studies (median survival or Kaplan–Meier curves) were reconstructed, revealing no significant difference in median survival time (hazard ratio = 0.91, I 2 = 47%, P = .55). Conclusion: For resectable pancreatic ductal adenocarcinoma, NAT achieves higher R0 resection rates and reduces major postoperative complications but does not improve survival compared with US.
Zuo et al. (2025) studied this question.