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.
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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.
