[Repositioning pancreatic surgery and pancreatic surgeons in the era of multidisciplinary treatment for pancreatic cancer].

Pancreatic ductal adenocarcinoma (PDAC) is characterized by early micrometastatic spread, highly aggressive tumor biology, and a high risk of recurrence. As a result, the traditional treatment paradigm centered on surgery alone has been insufficient to achieve sustained improvements in overall survival. Over the past five years, perioperative systemic treatment strategies have evolved substantially, with growing evidence supporting neoadjuvant and conversion therapies, more refined use of locally intensified modalities such as radiotherapy and ablation, and the gradual incorporation of biomarkers-including CA19-9, ctDNA, and molecular residual disease-into clinical research and practice. Together, these advances have accelerated a shift in PDAC management from a "resection-centered" model toward a comprehensive treatment paradigm focused on benefit across the entire disease course. Within this new paradigm，the value of pancreatic surgery has not diminished；rather，it has expanded from "achieving resection" to "designing the full treatment pathway and making key decisions at critical junctures".Its core responsibilities now include benefit-based stratification according to anatomy, tumor biology, and host condition; perioperative sequence management and ensuring treatment completion rates; dual quality control of oncologic adequacy and perioperative safety; recurrence risk stratification and integration of reintervention strategies; and the development of disease-specific center models driven by clinical research and real-world data. Accordingly, the role of the pancreatic surgeon must evolve from that of a "technical resectionist" to that of an "MDT pathway leader，perioperative treatment coordinator，local therapy integrator，and quality management steward". Drawing on recent guideline updates and pivotal clinical studies, this article systematically discusses the repositioning of pancreatic surgery and pancreatic surgeons in the era of multidisciplinary, integrated treatment.