International survey on neoadjuvant treatments in anatomically resectable pancreatic adenocarcinoma (INSPIRA): a real-life snapshot.

Publication/Presentation Date

10-26-2026

Abstract

BACKGROUND: Neoadjuvant therapy (NAT) has shown promising results in borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Together with the concept of biological resectability, this has raised interest in extending NAT to anatomically resectable PDAC (AR-PDAC).

METHODS: An international online survey was conducted among surgeons, oncologists, radiotherapists, and gastroenterologists to assess current perspectives on NAT in AR-PDAC.

RESULTS: A total of 391 responses from 61 countries were collected. Overall, 77% reported discussing all pancreatic cancer cases in multidisciplinary meetings. NAT was recommended only for selected AR-PDAC patients by 47% of respondents. The main selection criteria were elevated CA19-9 (74.6%), suspicious regional lymph nodes (63.4%), and suspected occult micro-metastases (55.6%). Disease progression during therapy, potentially precluding surgery, was a concern for 26.5%. However, 93.3% agreed that NAT can help assess tumor biology and avoid futile surgery in rapidly progressing disease. Regarding future practice, 53.6% anticipated NAT becoming standard care for all AR-PDAC, while 34.6% supported its use only in selected cases.

CONCLUSION: NAT for AR-PDAC attracts interest among surveyed clinicians worldwide. Although currently reserved mainly for selected patients, its potential to refine patient selection, avoid futile surgery, and support more aggressive surgical strategies in responders may encourage evaluation and adoption.

Volume

69

First Page

102580

Last Page

102580

ISSN

1879-3320

PubMedID

42950772

Department(s)

Department of Surgery

Document Type

Article

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