Assessing neoadjuvant therapy response in pancreatic cancer is crucial for improving surgical outcomes.

• A 50% decrease in CA19-9 levels correlated with better overall survival (32 months vs 24 months, p = 0.0028).
• Combining CA19-9 response with major pathologic response was linked to the best survival (40 months, p = 0.0086), though this occurred in only 9% of patients.

Surgeons should prioritize dual response indicators for optimal patient selection and prognostication.

• Neoadjuvant radiation therapy improved occurrence of this dual response (45% vs 11%, p < 0.001).