[Reshaping surgical strategies for pancreatic cancer in the era of neoadjuvant therapy: challenges and opportunities].

Abstract

With the widespread adoption of neoadjuvant therapy in pancreatic cancer, the traditional surgery-centered treatment paradigm is undergoing a profound shift. Against the background of upfront systemic therapy, surgery no longer naturally occupies the starting point of the treatment sequence; instead, its indications, timing, and expected benefits must be re-evaluated and redefined within the new treatment framework. By improving completion of the entire treatment course, enabling biological selection, and optimizing patient selection for surgical intervention, neoadjuvant therapy has driven a shift in resectability assessment from a purely anatomical judgment toward a comprehensive decision-making model that integrates tumor biology and treatment response. Nevertheless, surgical practice faces multiple challenges, including blurred boundaries of surgical indications, greater complexity in determining the optimal timing of surgery, evolving technical difficulty and perioperative risk, and the limitations of traditional evaluation frameworks. On this basis, the role of surgeons is evolving from executors of surgical techniques to central decision-makers within multidisciplinary teams, accompanied by increasing refinement of surgical strategies and ongoing innovation in surgical techniques and assessment concepts. Overall, the reshaping of surgical strategies for pancreatic cancer in the era of neoadjuvant therapy is not centered on the binary question of whether to operate, but rather on determining for whom, when, and how surgery should be performed, with the ultimate goal of achieving precise surgical decision-making oriented toward long-term survival benefit for patients.