Surgical resection significantly enhances survival in borderline resectable and locally advanced pancreatic cancer compared to continued oncology therapy.

• Median overall survival (OS) is 39.0 months after resection versus 16.7 months with oncology therapy (p < 0.0001).
• In a matched cohort, OS is 42.6 months with resection compared to 18.6 months with oncology therapy (p < 0.0001).

Selecting patients with favorable chemotherapy responses for surgery can lead to better outcomes.

• Resection remains advantageous even with postoperative mortality included in the analysis.