Pancreatic cancer: treatment sequence improves survival

By Elodie Vaz  | Published on February 18, 2026 | 3 min read

Long regarded as one of the most aggressive cancers, pancreatic cancer remains associated with high mortality despite therapeutic advances. At what is considered an “early” stage, surgery has historically been proposed as first-line treatment with curative intent. However, a study conducted at the Mayo Clinic suggests that this strategy may not be optimal for a substantial proportion of patients. Published in February in the Journal of the National Comprehensive Cancer Network (JNCCN), the findings show that treatment sequence directly influences survival, particularly when the tumor is in contact with a key vessel.

Pancreatic cancer is characterized by rapid progression, a strong tendency for dissemination, and relative resistance to treatment. Even at a stage considered resectable, prognosis remains poor. Neoadjuvant chemotherapy aims to reduce tumor burden, treat micrometastases early, and increase the likelihood of complete resection.

When treatment order becomes a key survival factor

  The researchers sought to determine whether treatment order—surgery first or chemotherapy before surgery—affected survival in patients with early-stage pancreatic cancer, particularly when the tumor was in contact with the superior mesenteric vein. The study analyzed more than 1,400 patients treated at Mayo Clinic centers in Minnesota, Arizona, and Florida. Investigators compared survival among patients who underwent upfront surgery with those who received neoadjuvant chemotherapy prior to surgery, taking into account the degree of tumor–vessel contact.

When the tumor was in contact with the superior mesenteric vein, patients who underwent immediate surgery had lower survival rates. In contrast, those who received chemotherapy before surgery showed survival comparable to patients without venous involvement. “Many patients with early-stage pancreatic cancer undergo upfront surgery because it has long been believed to offer the best chance for cure,” said Dr. Zhi Ven Fong, surgical oncologist and co-author of the study, in a press release. “Our findings suggest that chemotherapy first—even in cases considered more straightforward—offers patients the best chance of long-term survival.”

Toward a redefinition of ‘resectable’ tumors

Current National Comprehensive Cancer Network guidelines classify tumors with less than 180° venous contact as “upfront resectable.” However, the Mayo Clinic data suggest that any degree of venous involvement may warrant prior chemotherapy. “Our findings suggest that guidelines could be updated to reclassify tumors with any venous involvement as borderline resectable,” Dr. Fong stated.

These results support the approach already adopted at the Mayo Clinic, which favors chemotherapy before surgery for all patients. They pave the way for a redefinition of therapeutic standards and a broader reflection on personalized treatment pathways.

“We hope this study will encourage patients and clinicians to carefully consider the sequence of treatments,” concluded Dr. Mark Truty, surgical oncologist and co-author of the study. The next challenge is to translate these findings into national recommendations and to assess, in prospective trials, the impact of this strategy on long-term survival.



                      Read next: Cancer vaccines: a revolution underway?





About the author – Elodie Vaz 
Health journalist, graduated from the CFPJ in 2023, Élodie explores the marks that illnesses leave on bodies and, more broadly, on human life. A state-registered nurse since 2010, she spent twelve years at patients’ bedsides before trading her stethoscope for a notebook. She now examines the connections between environment and health, convinced that the vitality of life cannot be reduced to that of humans alone.