Is neoadjuvant therapy necessary for resectable pancreatic cancer? A review of randomized controlled trials to date: a narrative review.

Perioperative systemic therapy, administered either preoperatively (neoadjuvant therapy) or postoperatively (adjuvant therapy), has been considered a strategy to improve the long-term prognosis of pancreatic cancer. While adjuvant therapy following resection has demonstrated a clear long-term prognostic benefit, the significance of neoadjuvant therapy remains uncertain. This manuscript reviews previously published randomized controlled trials and provides a scientific discussion on the value of neoadjuvant therapy. To date, eight phase II or phase III randomized controlled trials have been conducted, but their results have been inconsistent. Clear evidence has not been established due to several factors, including differences in chemotherapy agents used across trials, variations in primary endpoints, and the inclusion of borderline resectable pancreatic cancer cases. Ongoing randomized controlled trials are expected to clarify the role of neoadjuvant therapy in resectable pancreatic cancer.