30-Second Takeaway
- Major pathologic response after preoperative therapy in PDAC is a powerful prognostic marker and may attenuate adjuvant chemotherapy benefit.
- A large FOLFIRINOX-based restaging calculator refines survival estimates in localized PDAC and guides whether to proceed with resection.
- Extensive multiorgan debulking for palliative mCRC increases serious adverse events without improving survival compared with chemotherapy alone.
Week ending March 21, 2026
Surgical oncology after neoadjuvant therapy: who to operate on, how extensively, and when to de-escalate
Major pathologic response after preoperative therapy independently predicts excellent survival in resected PDAC
This multi-institutional study analyzed 739 patients undergoing pancreatectomy after preoperative therapy for PDAC using Evans’ grading. Major pathologic response (Evans III/IV) occurred in 11.5% and was associated with markedly longer median overall survival (71.5 vs 40.9 months). Recurrence-free survival was also substantially prolonged with major response (55.5 vs 15.2 months). On multivariable analysis, major pathologic response remained an independent prognostic factor for overall survival.
Trans-Atlantic calculator uses restaging data after FOLFIRINOX to individualize survival in localized PDAC
The TAPS consortium studied 2338 patients with localized PDAC treated first-line with (modified) FOLFIRINOX. Baseline stage (borderline and locally advanced), tumor location, and WHO performance status independently predicted overall survival after restaging. Metastatic disease at restaging, post-induction CA19-9 level and change, and post-induction tumor size and change were additional independent prognostic factors. These eight variables stratified patients into four risk groups with 3-year survival ranging from 6.0% to 65.8%.
ORCHESTRA: extensive multiorgan debulking adds toxicity without survival gain in palliative mCRC
The ORCHESTRA randomized trial enrolled 382 patients with multiorgan mCRC eligible for at least 80% debulking after induction oxaliplatin-based chemotherapy. Patients were randomized to continue chemotherapy alone or undergo extensive tumor debulking plus chemotherapy. Median overall survival was similar: 27.5 months with chemotherapy alone versus 30.0 months with debulking (adjusted HR 0.88; 95% CI 0.70-1.10; P = .26). Progression-free survival was also comparable (10.4 vs 10.5 months; adjusted HR 0.83; 95% CI 0.67-1.02; P = .08).
Omitting axillary surgery preserves survival but increases axillary recurrence in clinically node-negative early breast cancer
This systematic review and meta-analysis pooled seven randomized trials including 8806 early breast cancer patients with clinically negative axillae. No axillary surgery was compared with sentinel node biopsy or axillary dissection. Overall survival was similar between groups (OR 1.02; 95% CI 0.86-1.20; p = 0.84). Disease-free survival also did not differ significantly (OR 0.80; 95% CI 0.63-1.00; p = 0.05).
References
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Additional Reads
Optional additional studies from this edition.