Detecting circulating tumor DNA (ctDNA) in patients with localized pancreatic ductal adenocarcinoma (PDAC) can help predict outcomes and guide surgical decision-making.

• Mutant KRAS ctDNA was present in 19% of patients at diagnosis, with levels dropping to 4.6% after neoadjuvant chemotherapy (NAC).
• The presence of both KRAS and TP53 ctDNA at diagnosis was associated with a nearly six-fold increased risk of shorter overall survival (OS) (adjusted hazard ratio 5.66, p < 0.001).
• Higher ctDNA variant allele frequency during treatment also indicated a worse prognosis (adjusted hazard ratio 1.14, p = 0.028).

These findings suggest that ctDNA assessments can be integral in evaluating treatment response and risk stratification in localized PDAC.

A study found that fibrosis scores significantly differ among pancreatic surgery patients with and without chronic pancreatitis (CP), suggesting that reliance on fibrosis for diagnosis may lead to overdiagnosis of CP.

• Median fibrosis scores increased from controls (0.33) to indeterminate CP (2.8), recurrent acute pancreatitis (6.5), and definite CP (8.5), with all groups differing significantly.
• In patients with genetic/idiopathic recurrent acute pancreatitis (≥7 episodes), fibrosis scores were comparable to those with chronic pancreatitis.

This highlights the need for caution in interpreting fibrosis levels when evaluating pancreatitis, particularly regarding diagnostic criteria for indeterminate cases.

Adding radiotherapy to neoadjuvant chemotherapy for resectable pancreatic ductal adenocarcinoma improved pathologic response rates but failed to enhance overall or event-free survival.

• Radiotherapy increased rates of pathologic complete response (6.6% vs. 4.4%) and R0 resections (85% vs. 52.2%).
• However, similar recurrence patterns were observed, with no significant difference in overall survival (HR 1.02) or event-free survival (HR 1.10).

Surgeons should note that despite improved pathological outcomes, the lack of survival benefit raises questions about the utility of routine radiotherapy in this context.

A new set of dual nomograms can effectively predict overall survival and recurrence risk following pancreatic resection for ductal adenocarcinoma, aiding surgical decision-making and postoperative management.

• Median overall survival post-resection was 22.4 months, with a 5-year survival rate of 18%.
• The nomogram for overall survival showed excellent discrimination (AUC 0.780), while the recurrence nomogram also performed well (AUC 0.732).
• Key predictors included ECOG performance status and adjuvant chemotherapy; peripancreatic fat infiltration significantly increased recurrence risk (OR 2.19).

These nomograms facilitate individual risk stratification, potentially guiding surveillance strategies and patient counseling.