Actual 5-year survival after neoadjuvant therapy and resection for localized pancreatic ductal adenocarcinoma is 34.5%, with early recurrence as the leading cause of treatment failure.

• Among 660 patients, recurrence occurred in 74.1%, predominantly within the first year post-surgery.
• Survival rates were stratified: 42.5% for resectable, 29.0% for borderline-resectable, and 17.5% for locally advanced disease.
• Key predictors for long-term survival included lower comorbidity, baseline CA19-9 <200 U/mL, and complete R0 resection.

Awareness of these survival outcomes and predictors can guide patient selection and management strategies in practice.