# Resectable pancreatic ductal adenocarcinoma

Source: https://onco.cc/cancers/resectable-pdac/  
OnCo record `resectable-pdac` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Resectable pancreatic cancer is the minority of pancreatic cancer that the surgeon can remove with clear margins because it has not wrapped around the main arteries or spread. Treatment is an operation, usually a Whipple procedure, followed by six months of combination chemotherapy, which is what turns surgery alone into a real chance of cure.

## Summary

Pancreatic ductal adenocarcinoma is called resectable when CT shows no contact with the superior mesenteric or coeliac arteries, no more than abutment of the portal or superior mesenteric vein, and no metastases. Most such tumours sit in the head of the gland and present with painless jaundice; body and tail tumours present later and are less often removable. Staging is a pancreas-protocol CT, a chest CT and CA 19-9, with endoscopic ultrasound and biopsy where the diagnosis is in doubt or neoadjuvant treatment is planned, and staging laparoscopy in some centres to find small peritoneal or liver deposits that CT misses.

The operation is a pancreatoduodenectomy (Whipple) for head tumours or a distal pancreatectomy with splenectomy for body and tail tumours, both with regional lymphadenectomy, increasingly by robotic or laparoscopic approach in high-volume centres. Surgery alone cures few patients: CONKO-001 (2007) showed that adjuvant gemcitabine roughly doubles the number alive without recurrence, ESPAC-4 (2017) that gemcitabine plus capecitabine does better, and PRODIGE 24 (2018) that six months of modified FOLFIRINOX after surgery gives the longest survival yet seen in the disease for patients fit enough to receive it. Roughly half of patients never complete adjuvant chemotherapy because of slow recovery, which is the main argument for giving some or all of it before surgery.

Whether upfront chemotherapy helps clearly resectable tumours is not settled: PREOPANC-1 showed a benefit for neoadjuvant chemoradiation over upfront surgery in a mixed resectable and borderline population, but NORPACT-1 (2024) found no survival gain from neoadjuvant FOLFIRINOX in resectable disease, and the ALLIANCE A021806 trial is testing the question with modern chemotherapy. Every patient should be offered germline testing, because a BRCA, PALB2 or ATM variant changes chemotherapy choice and matters to relatives. Recurrence is common even after a complete resection and adjuvant chemotherapy, most often in the liver, and adjuvant trials of personalised mRNA vaccines (autogene cevumeran) and of the pan-RAS inhibitor daraxonrasib are trying to lower it.

## Fields

- Kind: Cancer
- Last checked: 2026-09-18
- Also known as: Resectable pancreatic cancer; Operable pancreatic cancer; Early-stage PDAC; Stage I to II pancreatic adenocarcinoma
- Tags: subtype-page; gastrointestinal
- Group: gastrointestinal
- Burden: About one in five pancreatic cancers is judged removable at diagnosis, usually because a tumour in the head of the pancreas blocked the bile duct and caused jaundice early. It is the only stage at which the disease is routinely cured.
- Subtypes: Resectable PDAC of the pancreatic head (Whipple procedure); Resectable PDAC of the body or tail (distal pancreatectomy); Resectable PDAC with a raised CA 19-9 or large tumour (higher risk of occult spread, neoadjuvant chemotherapy considered); Resectable PDAC with a germline BRCA or PALB2 variant (platinum-based chemotherapy); Resectable PDAC arising in an IPMN (often earlier stage and better outcome)
- Biomarkers: Pancreas-protocol CT for vessel contact and metastases (defines resectability); CA 19-9 before and after surgery (prognosis, response, recurrence); Resection margin status (R0 versus R1) and lymph node ratio; Germline testing for BRCA1, BRCA2, PALB2, ATM and Lynch genes in every patient; Tumour KRAS, TP53, CDKN2A and SMAD4 status (prognostic; SMAD4 loss favours distant spread); Circulating tumour DNA after surgery (investigational marker of residual disease)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/resectable-pdac/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/resectable-pdac/#overview [4 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/resectable-pdac/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/resectable-pdac/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/resectable-pdac/#treating-it [6 settings, 4 decisions with options]
- Trials and papers (own page): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/resectable-pdac/evidence/ [101 trials, 29 key papers, 7 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/resectable-pdac/#science [3 targets, 2 pathways]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/resectable-pdac/where-you-are/ [32 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/resectable-pdac/#living-with-it [19 questions, 3 red cards, 1 decision aid]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/resectable-pdac/coming/ [10 medicines, 101 trials, 5 ideas, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/resectable-pdac/data/ [207 connected records]

## Standard of care

- Staging: Pancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery. ([CT (computed tomography)](https://onco.cc/technologies/ct/), [CA 19-9](https://onco.cc/terms/ca19-9/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/), [Biliary stenting and drainage](https://onco.cc/technologies/biliary-stenting-drainage/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/))
- Surgery: Pancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres. ([Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/))
- Adjuvant chemotherapy: Six months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [CONKO-001](https://onco.cc/trials/conko-001/), [ESPAC-4](https://onco.cc/trials/espac-4/))
- Neoadjuvant chemotherapy: Considered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [NORPACT-1](https://onco.cc/trials/norpact-1/))
- Germline testing: Offered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance. ([Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [High-risk pancreatic surveillance (CAPS / PRECEDE)](https://onco.cc/technologies/pancreatic-surveillance/))
- Follow-up: CA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease. ([CA 19-9](https://onco.cc/terms/ca19-9/), [CT (computed tomography)](https://onco.cc/technologies/ct/))

## State of the art

- Modified FOLFIRINOX after surgery (PRODIGE 24) is the adjuvant standard for fit patients and gives the longest survival recorded in a pancreatic cancer trial.
- Neoadjuvant chemotherapy is spreading to resectable disease so that every patient receives systemic treatment, though NORPACT-1 did not show a survival gain.
- Adjuvant trials of autogene cevumeran (personalised mRNA vaccine) and daraxonrasib are the first to attack recurrence with something other than chemotherapy.
- Robotic pancreatoduodenectomy and enhanced recovery programmes shorten recovery and help more patients reach adjuvant chemotherapy.

## Open problems

- Half of patients never complete adjuvant chemotherapy; whether giving it first helps clearly resectable tumours is unproven.
- Recurrence after a complete resection and full chemotherapy remains common, and no marker reliably identifies who is cured.
- Circulating tumour DNA and CA 19-9 kinetics are not yet validated to guide who needs more or less treatment.
- Outcomes differ sharply between high-volume and low-volume surgical centres.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Pancreatic_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Pancreatic_cancer
- NCCN Guidelines: Pancreatic Adenocarcinoma: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455

## Connected records

- cancers: [Ampullary cancer (ampulla of Vater)](https://onco.cc/cancers/ampullary/), [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [BRCA or PALB2-mutant pancreatic ductal adenocarcinoma](https://onco.cc/cancers/brca-palb2-pdac/), [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma)](https://onco.cc/cancers/ipmn-associated-carcinoma/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Pancreatic acinar cell carcinoma](https://onco.cc/cancers/pancreatic-acinar-cell-carcinoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Pancreatoblastoma](https://onco.cc/cancers/pancreatoblastoma/)
- technologies: [Biliary stenting and drainage](https://onco.cc/technologies/biliary-stenting-drainage/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/), [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [High-risk pancreatic surveillance (CAPS / PRECEDE)](https://onco.cc/technologies/pancreatic-surveillance/), [KRAS & RAS inhibitors](https://onco.cc/technologies/kras-inhibitors/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Personalised neoantigen (mRNA) vaccines](https://onco.cc/technologies/neoantigen-mrna-vaccine/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [KRAS](https://onco.cc/targets/kras/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Autogene cevumeran](https://onco.cc/drugs/autogene-cevumeran/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [ELI-002 7P](https://onco.cc/drugs/eli-002-7p/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Pancrelipase (pancreatic enzyme replacement therapy)](https://onco.cc/drugs/pancrelipase/), [Tegafur, gimeracil and oteracil (S-1)](https://onco.cc/drugs/tegafur-gimeracil-oteracil/)
- companies: [BioNTech](https://onco.cc/companies/biontech/), [Dutch Pancreatic Cancer Group](https://onco.cc/companies/dpcg/), [Elicio Therapeutics](https://onco.cc/companies/elicio-therapeutics/), [Revolution Medicines](https://onco.cc/companies/revolution-medicines/), [Roche / Genentech](https://onco.cc/companies/roche-genentech/)
- pathways: [Pancreatic cancer (KEGG map)](https://onco.cc/pathways/pancreatic-cancer-signalling/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/)
- terms: [CA 19-9](https://onco.cc/terms/ca19-9/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Classical versus basal-like (squamous) subtypes of pancreatic cancer, and GATA6](https://onco.cc/terms/classical-vs-basal-like/), [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer](https://onco.cc/terms/neoadjuvant-versus-upfront-surgery-pancreatic/), [New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score)](https://onco.cc/terms/new-onset-diabetes-pancreatic-cancer/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting)](https://onco.cc/terms/pancreas-protocol-ct/), [Pancreatic cancer trials open today (registry snapshot and UK sites)](https://onco.cc/terms/pancreatic-trials-open-today/), [Pancreatic cancer: the failed and stopped programmes and why](https://onco.cc/terms/pancreatic-failed-programmes/), [Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it](https://onco.cc/terms/pancreatic-enzyme-replacement/), [R0 and R1 margins in pancreatic cancer: the 1 mm rule and standardised specimen reporting](https://onco.cc/terms/r0-r1-margin-pancreatic/), [Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)](https://onco.cc/terms/nccn-resectability-criteria-pancreatic/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)](https://onco.cc/terms/vascular-resection-pancreatic/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)
- trials: [24BRO681 : Alternating Gnp and mFOLFIRINOX for BR-PDAC](https://onco.cc/trials/nct07043270/), [A Phase II Clinical Study Evaluating SSGJ-706 in Combination Therapy for Advanced Gastrointestinal Cancers](https://onco.cc/trials/nct07233850/), [A Phase II, EvaluateBLEX 404 Combined With Gemcitabine Monotherapy With Pancreatic Cancer](https://onco.cc/trials/nct03301805/), [A Single-arm, Open-label Clinical Study to Evaluate the Efficacy and Safety of VRT106 in Combination With Chemotherapy for Resectable Pancreatic Cancer](https://onco.cc/trials/nct06758544/), [A Study of NovoTTF-200T(P) in Combination With Gemcitabine and Nab-Paclitaxel for Resectable Pancreatic Adenocarcinoma](https://onco.cc/trials/nct05624918/), [A Study of the Efficacy and Safety of Adjuvant Autogene Cevumeran Plus Atezolizumab and mFOLFIRINOX Versus mFOLFIRINOX Alone in Participants With Resected PDAC](https://onco.cc/trials/nct05968326/), [A Study on Ivonescimab Plus Chemotherapy as Neoadjuvant Therapy for Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct06944106/), [Adebrelimab Combined With Chemotherapy for Neoadjuvant Therapy in Resectable Pancreatic Cancer](https://onco.cc/trials/nct06177522/), [Adjuvant Chemoradiotherapy Versus Chemotherapy for Pancreatic Cancer (ADJUPANC)](https://onco.cc/trials/nct06427447/), [AG Followed by FOLFIRINOX Both Combined With PD-L1 Antibodies as a Conversion Therapy for Borderline Resectable and Locally Advanced Pancreatic Cancer.](https://onco.cc/trials/nct07208539/), [Alliance A021806](https://onco.cc/trials/alliance-a021806/), [AMPLIFY-7P](https://onco.cc/trials/amplify-7p/), [APACT](https://onco.cc/trials/apact/), [APOLLO: A Randomized Phase II Double-Blind Study of Olaparib Versus Placebo Following Curative Intent Therapy in Patients With Resected Pancreatic Cancer and a](https://onco.cc/trials/nct04858334/), [Autogene cevumeran phase 1 in resected pancreatic cancer (Memorial Sloan Kettering)](https://onco.cc/trials/autogene-cevumeran-phase-1/), [CEB-01 in Locally Resectable Pancreatic Cancer](https://onco.cc/trials/nct06538857/), [Comparing Astragalus Plus Gemcitabine to Gemcitabine Alone as Neoadjuvant Treatment for Pancreatic Cancer Patients](https://onco.cc/trials/nct06234072/), [Comparing Neoadjuvant/Adjuvant GVAX vs a mKRASvax Given With Anti-PD-1 and Anti-CD137 for Surgically Resectable Pancreatic Cancer](https://onco.cc/trials/nct06782932/), [CONKO-001](https://onco.cc/trials/conko-001/), [CONKO-005](https://onco.cc/trials/conko-005/), [Conversion Surgery Vs. Palliative Care in Pancreatic Cancer Oligometastatic to the Liver](https://onco.cc/trials/nct06690528/), [DCE-MRI for Neoadjuvant Treatment Assessment in Patients With Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct07705919/), [Efficacy and Safety of TPIAT for Resectable Adenocarcinoma of the Pancreas Region at High Risk of Postoperative Fistula](https://onco.cc/trials/nct05116072/), [EGFR Targeted Photoimmunotherapy With ASP-1929 for Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct07698613/), [Endoscopic Ultrasound-Guided Loco-regional Chemotherapy Injection as Adjuvant Therapy for Locally Advanced Pancreatic Cancer.](https://onco.cc/trials/nct07429643/), [ESPAC-1](https://onco.cc/trials/espac-1/), [ESPAC-3](https://onco.cc/trials/espac-3/), [ESPAC-4](https://onco.cc/trials/espac-4/), [Examining Safety, Efficacy and Feasibility of Preoperative Propranolol in Patients With PDAC.](https://onco.cc/trials/nct06145074/), [Gemcitabine, Cisplatin and Nab-Paclitaxel as Neoadjuvant Treatment for Patients With Resectable or Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct06423326/), [Histamine Dihydrochloride and Interleukin-2 in Primary Resectable Pancreatic Cancer](https://onco.cc/trials/nct05810792/), [HR070803 in Combination With Oxaliplatin, 5-fluorouracil/LV Versus GX as Adjuvant Therapy for Pancreatic Cancer](https://onco.cc/trials/nct06217042/), [HR070803 in Combination With Oxaliplatin, S-1 Versus NALIRIFOX as Adjuvant Therapy for Pancreatic Cancer](https://onco.cc/trials/nct06383078/), [HRS-4642 in Combination With AG for Neoadjuvant and Adjuvant Treatment of Pancreatic Cancer](https://onco.cc/trials/nct06587061/), [HRS-4642 in Combination With Gemcitabine and Albumin-bound Paclitaxel and Adebrelimab for Neoadjuvant and Adjuvant Treatment of Pancreatic Cancer](https://onco.cc/trials/nct07131514/), [HRS-4642 in Combination With Nimotuzumab and Chemotherapy for BRPC With KRAS G12D Mutation](https://onco.cc/trials/nct07240766/), [Hypofractionated Radiotherapy +Chemotherapy+ Camrelizumab as Neoadjuvant Therapy for Pancreatic Cancer](https://onco.cc/trials/nct06435260/), [IBI343 Combined With Chemotherapy as Neoadjuvant Therapy in Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct07415525/), [Impact of Comprehensive Geriatric Management on Morbidity and Quality of Life in Elderly Patients Undergoing Major Hepatectomy and Pancreaticoduodenectomy for C](https://onco.cc/trials/nct06999512/), [Investigational Scan (68Ga-FAPI-46 PET/CT) for Imaging of Cancer-Associated Fibroblasts for Localized Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct05518903/), [Irinotecan Liposome for Resectable Pancreatic Cancer With or Without Addebelizumab](https://onco.cc/trials/nct06172036/), [Is Intraperitoneal Drainage Necessary Following Distal Pancreatectomy?](https://onco.cc/trials/nct05720338/), [JASPAC 01](https://onco.cc/trials/jaspac-01/), [KRAS Neoantigen Nanovaccine as Adjuvant Therapy for Colorectal Cancer/Pancreatic Cancer](https://onco.cc/trials/nct07353645/), [Lanreotide Versus Placebo Before Surgery to Prevent a Surgical Complication Called a Pancreatic Fistula](https://onco.cc/trials/nct06807437/), [Liposomal Irinotecan in Combination With Oxaliplatin and S-1 Versus Gemcitabine Combined With Capecitabine as Postoperative Adjuvant Therapy for Pancreatic Canc](https://onco.cc/trials/nct06571461/), [Liposomal Irinotecan, 5-fluorouracil/Calcium Folinate, Oxaliplatin, and Adebrelimab in Combination With Radiotherapy for Resectable or Borderline Resectable Pan](https://onco.cc/trials/nct07542002/), [Liquid Biopsy (ctDNA) Guided Treatment in Localized Pancreatic Cancer: Neoadjuvant CTX vs. Upfront Surgery](https://onco.cc/trials/nct06391892/), [mFOLFIRINOX as Adjuvent Chemotherapy in Treating Chinese Pancreatic Cancer Patients](https://onco.cc/trials/nct04084496/), [Modulation of the Gut Microbiome With Pembrolizumab Following Chemotherapy in Resectable Pancreatic Cancer](https://onco.cc/trials/nct05462496/), [Mutant KRAS G12V-specific TCR Transduced T Cell Therapy for Advanced Pancreatic Cancer](https://onco.cc/trials/nct04146298/), [Neoadjuvant Avutometinib/Defactinib and mFOLFIRINOX Combination Therapy in Pancreatic Adenocarcinoma](https://onco.cc/trials/nct07824960/), [Neoadjuvant Chemotherapy for Pancreatic Cancer Followed by GS and GnP](https://onco.cc/trials/nct05268692/), [Neoadjuvant Folfirinox Combined With Pembrolizumab Followed by Surgery for Patients With Resectable Pancreatic Cancer](https://onco.cc/trials/nct05132504/), [Neoadjuvant HRS-4642 Plus Chemotherapy With or Without Immunotherapy for Pancreatic Cancer](https://onco.cc/trials/nct07691593/), [Neoadjuvant Treatment vs Upfront Surgery for Left-Sided Pancreatic Cancer](https://onco.cc/trials/nct07155629/), [Neoadjuvant Triple Therapy for (Borderline) Resectable Pancreatic Cancer (PREOPANC-5)](https://onco.cc/trials/nct06384560/), [Neoadjuvant vs Upfront Surgery for Resectable Pancreatic Cancer and Periampullary Cancer](https://onco.cc/trials/nct07081360/), [Neoadjuvant/Adjuvant Sintilimab, Nab-paclitaxel, and Gemcitabine for Resectable/Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct05562297/), [NeoFOL-R Trial (Perioperative Versus Adjuvnat FOLFIRINOX in Resectable Pancreatic Cancer)](https://onco.cc/trials/nct05529940/), [NEONAX](https://onco.cc/trials/neonax/), [Nimotuzumab Combined With GX as Postoperative Adjuvant Therapy in Pancreatic Cancer](https://onco.cc/trials/nct06409429/), [Nimotuzumab Combined With mFOLFIRINOX/GX as Postoperative Adjuvant Therapy in Pancreatic Cancer](https://onco.cc/trials/nct06389760/), [Nimotuzumab Combined With Nab-paclitaxel/Gemcitabine in the Perioperative Treatment of High-risk Resectable/Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct07277452/), [NIR-Fluorescence Guided Surgical Resection of Neoadjuvant Treated Localized Pancreatic Cancer Using SGM-101](https://onco.cc/trials/nct05984810/), [NORPACT-1](https://onco.cc/trials/norpact-1/), [Pancreatic Cancer Adaptive Neoadjuvant Chemotherapy Trial](https://onco.cc/trials/nct03322995/), [Pancreatic Parenchymal Injection of N-butyl-2-cyanoacrylate](https://onco.cc/trials/nct07230509/), [Panitumumab-IRDye800 in Patients With Pancreatic Cancer Undergoing Surgery](https://onco.cc/trials/nct03384238/), [PDAC Regression and Intraoperative Surgical Margin With Neoadjuvant TAMP (PRISM-TAMP)](https://onco.cc/trials/nct07477418/), [Perioperative Platelet Inhibition With Acetylsalicylic Acid in Patients With Resectable Tumors of the Pancreatic Head](https://onco.cc/trials/nct05637567/), [Perioperative Treatment in High-risk Resectable Pancreatic Cancer With NALIRIFOX](https://onco.cc/trials/nct06210360/), [Personalized Tumor Neoantigen MRNA Therapy Adjuvant Treatment for Postoperative Pancreatic Cancer.](https://onco.cc/trials/nct06888674/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [PREOPANC-2](https://onco.cc/trials/preopanc-2/), [PREOPANC-3](https://onco.cc/trials/preopanc-3/), [Preoperative mFOLFIRINOX (or Gem-Nab-P) +/- Isotoxic High-dose SBRT for Borderline Resectable Pancreatic Adenocarcinoma](https://onco.cc/trials/nct05083247/), [Preoperative Stereotactic Body Radiation Therapy in Patients With Resectable Pancreatic Cancer](https://onco.cc/trials/nct05679583/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [PULSAR in Systemic Therapy for Pancreatic Cancer](https://onco.cc/trials/nct07269626/), [PurIST Classification-Guided Adaptive Neoadjuvant Chemotherapy by RNA Expression Profiling of EUS Aspiration Samples](https://onco.cc/trials/nct04683315/), [Radiotherapy With GX Regimen as Adjuvant Therapy for High-risk Patients Following Pancreatic Cancer Surgery](https://onco.cc/trials/nct07632118/), [Radiotherapy With Sequential Chemotherapy Combined With PD-1 Inhibitor and Thymalfasin for BRPC](https://onco.cc/trials/nct06573398/), [Rectus Sheath Block With Liposomal Bupivacaine Versus Thoracic Epidural Analgesia for Pain Control Following Pancreatoduodenectomy](https://onco.cc/trials/nct06411795/), [Reinforced Pancreaticojejunostomy With or Without glubran2](https://onco.cc/trials/nct06756074/), [Risk-adapted Adjuvant Chemotherapy Guided by the Tumour Stage for Operated Pancreatic Adenocarcinoma Following Neoadjuvant Chemotherapy With mFOLFIRINOX](https://onco.cc/trials/nct07044453/), [Safety and Efficacy of Immuncell-LC With Gemcitabine in Resectable Pancreatic Cancer](https://onco.cc/trials/nct04969731/), [SMAD4 Tailored Neoadjuvant Therapy for the Treatment of Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma, SMART-PANC Trial](https://onco.cc/trials/nct07748611/), [Standard or Prolonged Neoadjuvant Chemotherapy Before Surgery for BR/LAPC](https://onco.cc/trials/nct06714604/), [Stereotactic Body Radiation Therapy Followed by NALIRIFOX vs NALIRIFOX for Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct06259058/), [Stereotactic Body Radiotherapy Plus FAK and RAF/MEK Inhibition in Advanced Pancreatic Adenocarcinoma](https://onco.cc/trials/nct07126158/), [Stimulation With Bethanechol in Combination With Gemcitabine and Nab-paclitaxel in Pancreatic Adenocarcinoma](https://onco.cc/trials/nct05241249/), [Study of Adjuvant Nimotuzumab Combined with Nab-paclitaxel+ Gemcitabine in EGFR-positive Pancreatic Cancer](https://onco.cc/trials/nct06722911/), [Study of Daraxonrasib (RMC-6236) in Patients With Resected Pancreatic Ductal Adenocarcinoma (PDAC)](https://onco.cc/trials/nct07252232/), [Surufatinib in Combination With Iparomlimab and Tuvonralimab Injection and AG Chemotherapy for Neoadjuvant Therapy of HRPC or BRPC](https://onco.cc/trials/nct07833241/), [Surufatinib Plus Gemcitabine and Nab-paclitaxel vs. Gemcitabine Plus Nab-paclitaxel in Neoadjuvant Therapy for High - Risk Resectable or Borderline Resectable P](https://onco.cc/trials/nct07436741/), [Surufatinib Plus mFOLFIRINOX and PD-1 Inhibitor as the Neoadjuvant Therapy for High-risk or Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct07469956/), [SWOG S1505](https://onco.cc/trials/swog-s1505/), [Tele-PancFit: A Multi-site Trial of Video-based Strengthening Exercise Prehabilitation for Patients With Resectable Pancreatic Cancer](https://onco.cc/trials/nct05836870/), [Testing the Combination of Two Approved Chemotherapy Drugs and Radiation Prior to Surgery in Localized Pancreatic Cancer](https://onco.cc/trials/nct03492671/), [Tissue Adhesive Glue Modified Cyanoacrylate (Glubran® 2) in Soft Pancreas](https://onco.cc/trials/nct07155525/)
- people: [Eileen M. O'Reilly](https://onco.cc/people/eileen-oreilly/), [Jürgen Weitz](https://onco.cc/people/jurgen-weitz/), [Marc G. Besselink](https://onco.cc/people/marc-besselink/), [Paula Ghaneh](https://onco.cc/people/paula-ghaneh/), [Richard Schulick](https://onco.cc/people/richard-schulick/), [Thierry Conroy](https://onco.cc/people/thierry-conroy/), [Vinod P. Balachandran](https://onco.cc/people/vinod-balachandran/)
- key papers: [A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer](https://onco.cc/key-papers/paper-espac-1-chemoradiotherapy-chemotherapy-resected-pancreatic-nejm-2004/), [Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial](https://onco.cc/key-papers/paper-conko-001-adjuvant-gemcitabine-observation-jama-2007/), [Association of alterations in main driver genes with outcomes of patients with resected pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-qian-driver-genes-outcomes-resected-pancreatic-jama-oncol-2018/), [Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer](https://onco.cc/key-papers/paper-burris-gemcitabine-pancreatic-jco-1997/), [Circulating tumor DNA as a clinical test in resected pancreatic cancer](https://onco.cc/key-papers/paper-groot-kras-ctdna-clinical-test-resected-pancreatic-ccr-2019/), [Circulating tumor DNA as a potential marker of adjuvant chemotherapy benefit following surgery for localized pancreatic cancer](https://onco.cc/key-papers/paper-lee-ctdna-adjuvant-benefit-localized-pancreatic-ann-oncol-2019/), [Clinical implications of genomic alterations in the tumour and circulation of pancreatic cancer patients](https://onco.cc/key-papers/paper-sausen-ctdna-pancreatic-resection-nat-commun-2015/), [Combined circulating tumor DNA and protein biomarker-based liquid biopsy for the earlier detection of pancreatic cancers](https://onco.cc/key-papers/paper-cohen-ctdna-protein-liquid-biopsy-pancreatic-pnas-2017/), [CONKO-001: adjuvant gemcitabine and long-term outcomes after resected pancreatic cancer](https://onco.cc/key-papers/paper-conko-001-adjuvant-gemcitabine-long-term-oettle-jama-2013/), [Deleterious germline mutations in patients with apparently sporadic pancreatic adenocarcinoma](https://onco.cc/key-papers/paper-shindo-germline-sporadic-pancreatic-jco-2017/), [ESPAC-3: adjuvant fluorouracil plus folinic acid versus gemcitabine after pancreatic cancer resection](https://onco.cc/key-papers/paper-espac-3-fluorouracil-vs-gemcitabine-adjuvant-neoptolemos-jama-2010/), [ESPAC-4: adjuvant gemcitabine plus capecitabine versus gemcitabine alone after resection of pancreatic cancer](https://onco.cc/key-papers/paper-espac-4-gemcitabine-capecitabine-adjuvant-pancreatic-lancet-2017/), [Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-prodige-24-five-year-outcomes-jama-oncol-2022/), [Germline cancer susceptibility gene variants, somatic second hits, and survival outcomes in patients with resected pancreatic cancer](https://onco.cc/key-papers/paper-yurgelun-germline-second-hits-resected-pancreatic-genet-med-2019/), [Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial](https://onco.cc/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/), [NORPACT-1: neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer](https://onco.cc/key-papers/paper-norpact-1-neoadjuvant-folfirinox-labori-lancet-gastroenterol-hepatol-2024/), [Pancreatic cancer genomes reveal aberrations in axon guidance pathway genes](https://onco.cc/key-papers/paper-biankin-pancreatic-exomes-axon-guidance-nature-2012/), [Plasma circulating tumor DNA in pancreatic cancer patients is a prognostic marker](https://onco.cc/key-papers/paper-pietrasz-ctdna-prognostic-pancreatic-ccr-2017/), [Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update](https://onco.cc/key-papers/paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019/), [PREOPANC long-term results: neoadjuvant gemcitabine-based chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer](https://onco.cc/key-papers/paper-preopanc-neoadjuvant-chemoradiotherapy-long-term-jco-2022/), [Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial](https://onco.cc/key-papers/paper-preopanc-preoperative-chemoradiotherapy-jco-2020/), [Preservation of the pylorus in pancreaticoduodenectomy](https://onco.cc/key-papers/paper-traverso-longmire-pylorus-preservation-pancreaticoduodenectomy-sgo-1978/), [PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer](https://onco.cc/key-papers/paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018/), [Risk of Neoplastic Progression in Individuals at High Risk for Pancreatic Cancer Undergoing Long-term Surveillance](https://onco.cc/key-papers/paper-canto-caps-long-term-surveillance-gastroenterology-2018/), [RNA neoantigen vaccines prime long-lived CD8+ T cells in pancreatic cancer](https://onco.cc/key-papers/paper-sethna-rna-neoantigen-vaccine-long-lived-t-cells-nature-2025/), [Rojas 2023: a personalised mRNA vaccine trained T cells against each patient's pancreatic cancer, and those who responded stayed cancer-free longer](https://onco.cc/key-papers/paper-rojas-mrna-neoantigen-vaccine-pancreatic-nature-2023/), [Stratification of pancreatic ductal adenocarcinomas based on tumor and microenvironment features](https://onco.cc/key-papers/paper-puleo-pancreatic-tumour-microenvironment-subtypes-gastroenterology-2018/), [The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival](https://onco.cc/key-papers/paper-dbouk-caps5-stage-survival-jco-2022/), [Treatment of carcinoma of the ampulla of Vater](https://onco.cc/key-papers/paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935/)
- ideas: [Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed](https://onco.cc/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/), [Four weeks of training and nutrition before major cancer surgery, as standard](https://onco.cc/ideas/idea-bio2-prehabilitation-standard/), [Personalised vaccines given only when the blood test turns positive](https://onco.cc/ideas/idea-bio2-mrd-triggered-neoantigen-vaccine/), [RAS inhibitor combinations and sequence: pan-RAS plus G12D-selective, plus chemotherapy, and what to give after progression](https://onco.cc/ideas/idea-pdac-ras-inhibitor-combinations-and-sequencing/), [RAS(ON) inhibitors to convert unresectable pancreatic cancer to resectable](https://onco.cc/ideas/idea-ras-inhibitor-neoadjuvant-pdac/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- biomarkers: [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/)

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JSON: https://onco.cc/api/v1/entities/resectable-pdac.json