Histopathologic response predicts better survival in pancreatic cancer patients despite imaging showing stable or progressive disease.

• 89% of patients completed neoadjuvant therapy; 73% underwent resection.
• Radiographic response was low: 27% had tumor regression, while 66% had stable disease.
• 83% achieved significant serum CA 19-9 reduction, and 74% showed histopathologic response after resection, including 8% with complete response.

Histopathologic outcomes are vital for predicting long-term survival and should inform surgical decision-making.