Intraoperative radiation therapy (IORT) may significantly improve outcomes for patients with borderline resectable and locally advanced pancreatic cancer undergoing pancreatectomy.

• Local recurrence-free survival at 24 months improved to 79% with IORT vs. 53% without (p = .049).
• Overall survival at 24 months was 58% for IORT patients compared to 43% for controls (p = .058).

These findings suggest IORT offers better local control without increasing complications, supporting its consideration in surgical practice.

• Major complications were similar: 10% in IORT vs. 21% in controls.