Achieving a major pathologic response (mpr) after preoperative treatment for pancreatic ductal adenocarcinoma significantly impacts survival rates.

• Mpr was noted in just 11.5% of patients, but those who achieved it had a median overall survival of 71.5 months, compared to 40.9 months for non-mpr patients.
• Recurrence-free survival also improved, with mpr patients experiencing 55.5 months versus 15.2 months in the non-mpr group.

Understanding and predicting mpr can help tailor postoperative management, as adjuvant chemotherapy was not an independent prognostic factor for mpr patients.

• Factors predicting mpr include chemoradiotherapy, preoperative treatment duration of 6 months or more, and normal carbohydrate antigen 19-9 levels post-treatment.