Neoadjuvant chemotherapy’s benefit in early-stage pancreatic ductal adenocarcinoma is questionable due to bias in survival estimates.

• In a study of 13,466 patients, those receiving neoadjuvant chemotherapy showed initially longer median survival (33.4 vs. 25.7 months) but this disappeared after correcting for immortal time bias.
• Three robust statistical methods revealed no significant survival advantage for neoadjuvant therapy compared to upfront surgery.

Surgeons should reconsider the routine use of neoadjuvant chemotherapy in this patient population, focusing on more reliable data for decision-making.