Surgeons should note that preoperative treatment duration over six months significantly improves survival outcomes for patients undergoing conversion surgery for unresectable locally advanced pancreatic cancer.

• Patients receiving >6 months of preoperative treatment showed median overall survival of 50.4 months versus 29.7 months for those with ≤6 months (p<0.001).
• Identifying four key prognostic factors can stratify risk: long treatment duration, FOLFIRINOX regimen, normal tumor markers, and high nutritional index.

These findings could enhance patient selection and treatment planning in surgical settings.

• Patients with three or more favorable factors had a 5-year survival rate of 59.8%, compared to 26.3% for those with fewer.