Actual five-year survival after pancreatic resection, and what predicts it

Design

Retrospective cohort, two high-volume centres, 2015 to 2021, complete follow-up only

Population

660 patients with localized pancreatic ductal adenocarcinoma after neoadjuvant therapy and resection

Primary outcome

Actual five-year survival from surgery

Effect

34.5% overall; 62% and 82% if recurrence-free at one and two years; 42.5% to 17.5% across stages

Survival figures for resected pancreatic cancer usually come from actuarial estimates. This study instead reports actual five-year survival in 660 patients with localized pancreatic ductal adenocarcinoma who had neoadjuvant therapy then curative-intent pancreatectomy at two high-volume centres, counting only those with death or at least five years of follow-up.

Actual five-year survival was 34.5%, higher than the field often assumes. Recurrence occurred in 74.1% and was mostly early, with nearly two-thirds of recurrences in those who died before five years happening within the first year. Staying recurrence-free changed the outlook sharply: the probability of five-year survival rose to 62% among those recurrence-free at one year and 82% at two years. By stage at diagnosis, actual five-year survival was 42.5% in resectable, 29.0% in borderline-resectable and 17.5% in locally advanced disease. Low comorbidity, CA19-9 under 200, resectable disease, ypT0-1 and an R0 resection independently predicted long-term survival.

This lets surgeons counsel more precisely. Early systemic failure drives most deaths, so completing effective systemic therapy matters as much as the operation, and a patient who reaches two years recurrence-free can be given genuinely encouraging numbers.

• Actual five-year survival after neoadjuvant therapy and resection for localized pancreatic cancer was 34.5% across 660 patients.
• Being recurrence-free at two years raised the probability of five-year survival to about 82%.
• Actual five-year survival fell from 42.5% in resectable to 17.5% in locally advanced disease.
• Most recurrences were early and systemic, so completing systemic therapy is as important as the resection.
• CA19-9 under 200, resectable disease, ypT0-1 stage and R0 resection marked the best long-term outlook.

Why it matters

It replaces vague pessimism with stage-specific and landmark numbers a surgeon can actually give a patient after surgery.

Don't overread it

This was a retrospective cohort from two high-volume centres, so the figures may be better than those achievable in lower-volume practice.

The statistics, in plain English

Actual survival counts who is really alive at five years rather than projecting from a curve, so it is more honest but tied to this period and these two centres; the conditional survival figures describe patients who have already passed a landmark, not everyone at the outset.

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