Resectable pancreatic ductal adenocarcinoma
Resectable pancreatic cancer is the minority of pancreatic cancer that the surgeon can remove with clear margins because it has not wrapped around the main arteries or spread. Treatment is an operation, usually a Whipple procedure, followed by six months of combination chemotherapy, which is what turns surgery alone into a real chance of cure.
Overview
Pancreatic ductal adenocarcinoma is called resectable when CT shows no contact with the superior mesenteric or coeliac arteries, no more than abutment of the portal or superior mesenteric vein, and no metastases. Most such tumours sit in the head of the gland and present with painless jaundice; body and tail tumours present later and are less often removable. Staging is a pancreas-protocol CT, a chest CT and CA 19-9, with endoscopic ultrasound and biopsy where the diagnosis is in doubt or neoadjuvant treatment is planned, and staging laparoscopy in some centres to find small peritoneal or liver deposits that CT misses.
The operation is a pancreatoduodenectomy (Whipple) for head tumours or a distal pancreatectomy with splenectomy for body and tail tumours, both with regional lymphadenectomy, increasingly by robotic or laparoscopic approach in high-volume centres. Surgery alone cures few patients: CONKO-001 (2007) showed that adjuvant gemcitabine roughly doubles the number alive without recurrence, ESPAC-4 (2017) that gemcitabine plus capecitabine does better, and PRODIGE 24 (2018) that six months of modified FOLFIRINOX after surgery gives the longest survival yet seen in the disease for patients fit enough to receive it. Roughly half of patients never complete adjuvant chemotherapy because of slow recovery, which is the main argument for giving some or all of it before surgery.
Whether upfront chemotherapy helps clearly resectable tumours is not settled: PREOPANC-1 showed a benefit for neoadjuvant chemoradiation over upfront surgery in a mixed resectable and borderline population, but NORPACT-1 (2024) found no survival gain from neoadjuvant FOLFIRINOX in resectable disease, and the ALLIANCE A021806 trial is testing the question with modern chemotherapy. Every patient should be offered germline testing, because a BRCA, PALB2 or ATM variant changes chemotherapy choice and matters to relatives. Recurrence is common even after a complete resection and adjuvant chemotherapy, most often in the liver, and adjuvant trials of personalised mRNA vaccines (autogene cevumeran) and of the pan-RAS inhibitor daraxonrasib are trying to lower it.
State of the art
- Adjuvant trials of autogene cevumeran (personalised mRNA vaccine) and daraxonrasib are the first to attack recurrence with something other than chemotherapy.
- Robotic pancreatoduodenectomy and enhanced recovery programmes shorten recovery and help more patients reach adjuvant chemotherapy.
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Modified FOLFIRINOX after surgery (PRODIGE 24) is the adjuvant standard for fit patients and gives the longest survival recorded in a pancreatic cancer trial.
- Neoadjuvant chemotherapy is spreading to resectable disease so that every patient receives systemic treatment, though NORPACT-1 did not show a survival gain.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowBlood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
See all on the product pages:CapecitabineFOLFIRINOX / mFOLFIRINOXGemcitabineGemcitabine + nab-paclitaxel·Printable cards in the navigator
Anatomy and lymph node drainage
- Pancreatic head (most PDAC)
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- Gallbladder
- Nodes: peripancreatic
- Nodes: hepatic hilar
- Nodes: coeliac and superior mesenteric
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
- Pancreatic head (most PDAC)Resectable PDAC of the pancreatic head (Whipple procedure) · Resectable PDAC of the body or tail (distal pancreatectomy) · Resectable PDAC with a raised CA 19-9 or large tumour (higher risk of occult spread, neoadjuvant chemotherapy considered) · Resectable PDAC with a germline BRCA or PALB2 variant (platinum-based chemotherapy) · Resectable PDAC arising in an IPMN (often earlier stage and better outcome)
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile ductResectable PDAC of the body or tail (distal pancreatectomy)
- Gallbladder
- peripancreatic
- hepatic hilar
- coeliac and superior mesenteric
Same organ: Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder cancer, Ampullary cancer (ampulla of Vater), Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma
About one in five pancreatic cancers is judged removable at diagnosis, usually because a tumour in the head of the pancreas blocked the bile duct and caused jaundice early. It is the only stage at which the disease is routinely cured.
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- Liquid biopsy (ctDNA)Standard of care
Nothing recorded yet.
Nothing recorded yet.
Background: CA 19-9. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Pancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery.
Pancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres.
Six months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery.
Considered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against.
Offered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance.
CA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease.
Subtypes & biomarkers
top- Resectable PDAC of the pancreatic head (Whipple procedure)
- Resectable PDAC of the body or tail (distal pancreatectomy)
- Resectable PDAC with a raised CA 19-9 or large tumour (higher risk of occult spread, neoadjuvant chemotherapy considered)
- Resectable PDAC with a germline BRCA or PALB2 variant (platinum-based chemotherapy)
- Resectable PDAC arising in an IPMN (often earlier stage and better outcome)
- Pancreas-protocol CT for vessel contact and metastases (defines resectability)
- CA 19-9 before and after surgery (prognosis, response, recurrence)
- Resection margin status (R0 versus R1) and lymph node ratio
- Germline testing for BRCA1, BRCA2, PALB2, ATM and Lynch genes in every patient
- Tumour KRAS, TP53, CDKN2A and SMAD4 status (prognostic; SMAD4 loss favours distant spread)
- Circulating tumour DNA after surgery (investigational marker of residual disease)
How often this target appears
- 1935Allen Whipple describes the pancreatoduodenectomy that carries his name
- 2007CONKO-001: adjuvant gemcitabine after resection lengthens disease-free survival
- 2017ESPAC-4: gemcitabine plus capecitabine beats gemcitabine alone after surgery
- 2018PRODIGE 24: six months of modified FOLFIRINOX after surgery sets the adjuvant standard
- 2020PREOPANC-1: neoadjuvant chemoradiation before surgery improves long-term survival in resectable and borderline disease
- 2023Autogene cevumeran phase 1: personalised mRNA vaccine after surgery raises T cells that track with staying recurrence-free
- 2024NORPACT-1: neoadjuvant FOLFIRINOX does not lengthen survival in clearly resectable disease
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 11 changes by month →- 2026-09-18This recordResectable pancreatic ductal adenocarcinomaFacts on this page last checked
When this page itself was last checked or edited.
- 2026Trial resultAMPLIFY-7PAMPLIFY-7P reported
Primary DFS endpoint not met.
- 2024MilestoneFOLFIRINOX / mFOLFIRINOXNORPACT-1: neoadjuvant FOLFIRINOX does not lengthen survival in clearly resectable disease
A milestone in how this cancer is treated.
- 2023MilestoneAutogene cevumeranAutogene cevumeran phase 1: personalised mRNA vaccine after surgery raises T cells that track with staying recurrence-free
A milestone in how this cancer is treated.
- 2022Trial resultPREOPANC-1 / PREOPANC-2PREOPANC-1 / PREOPANC-2 reported
PREOPANC-1 5-year OS 20.
- 2020MilestonePREOPANC-1 / PREOPANC-2PREOPANC-1: neoadjuvant chemoradiation before surgery improves long-term survival in resectable and borderline disease
A milestone in how this cancer is treated.
What is in development for Resectable pancreatic ductal adenocarcinoma, drawn from the whole corpus: 14 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Drugs in phase 2 · 2
Technologies being tested · 2
Trials under way · 4
- A Study of the Efficacy and Safety of Adjuvant Autogene Cevumeran Plus Atezolizumab and mFOLFIRINOX Versus mFOLFIRINOX Alone in Participants With Resected PDAC · phase 2 · Genentech, Inc.
- Study of Daraxonrasib (RMC-6236) in Patients With Resected Pancreatic Ductal Adenocarcinoma (PDAC) · phase 3 · Revolution Medicines, Inc.
- CEB-01 in Locally Resectable Pancreatic Cancer · phase 2 · CEBIOTEX
- Safety and Efficacy of Immuncell-LC With Gemcitabine in Resectable Pancreatic Cancer · phase 3 · GC Cell Corporation
Trials reported · 3
- AMPLIFY-7P · phase 1/2 · 2026 · negative
- PREOPANC-1 / PREOPANC-2 · phase 3 · 2022 · mixed
- PRODIGE 24 / CCTG PA6 · phase 3 · 2018 · positive
Ideas not yet in a trial · 3
Open problems and what is being done
Half of patients never complete adjuvant chemotherapy; whether giving it first helps clearly resectable tumours is unproven.
Recurrence after a complete resection and full chemotherapy remains common, and no marker reliably identifies who is cured.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseBackground: Circulating tumour DNA (ctDNA), Minimal / molecular residual disease (MRD), Neoadjuvant / adjuvant / perioperative. Also on OnCo: Treatment journeys · Survivorship planner.
Circulating tumour DNA and CA 19-9 kinetics are not yet validated to guide who needs more or less treatment.
Outcomes differ sharply between high-volume and low-volume surgical centres.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
New York · cancer center | United States | 0 | 5,100 | 94,456 | #1 | ||
Seoul · hospital | South Korea | none recorded | 0 | 464 | 3,248 | #22 | |
Amsterdam · cancer center | Netherlands | none recorded | 0 | 1,451 | 25,873 | #45 | |
Paris · consortium | France | none recorded | 1 | not matched | - | - | |
Shanghai · hospital | China | none recorded | 0 | 2,872 | 31,534 | - | |
Sydney · cancer center | Australia | none recorded | 0 | 2,222 | 33,278 | - | |
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
Guangzhou · hospital | China | none recorded | 0 | 1,245 | 12,931 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Beijing · hospital | China | none recorded | 0 | 1,154 | 11,808 | - | |
L'Hospitalet de Llobregat · cancer center | Spain | 0 | 988 | 14,310 | - | ||
Rotterdam · cancer center | Netherlands | none recorded | 0 | 852 | 12,180 | - | |
Philadelphia, PA · cancer center | United States | 0 | 755 | 12,225 | - | ||
Guangzhou · hospital | China | none recorded | 0 | 704 | 7,832 | - | |
Philadelphia, PA · hospital | United States | none recorded | 0 | 695 | 9,931 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Resectable pancreatic ductal adenocarcinoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Resectable pancreatic ductal adenocarcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Pancreas-protocol CT for vessel contact and metastases, CA 19-9 before and after surgery, Resection margin statusand lymph node ratio, Germline testing for BRCA1, BRCA2, PALB2, ATM and Lynch genes in every patient, Tumour KRAS, TP53, CDKN2A and SMAD4 status), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Resectable PDAC of the pancreatic head, Resectable PDAC of the body or tail, Resectable PDAC with a raised CA 19-9 or large tumour.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Staging
- For my situation (staging), which of the standard options do you recommend and why?Why: Guideline options include: Pancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery.
Surgery
- For my situation (surgery), which of the standard options do you recommend and why?Why: Guideline options include: Pancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres.
Adjuvant chemotherapy
- For my situation (adjuvant chemotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Six months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery.
- Am I a candidate for FOLFIRINOX / mFOLFIRINOX, Gemcitabine, Capecitabine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PRODIGE 24 / CCTG PA6 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Neoadjuvant chemotherapy
- For my situation (neoadjuvant chemotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Considered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against.
- Am I a candidate for FOLFIRINOX / mFOLFIRINOX, Gemcitabine + nab-paclitaxel, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PREOPANC-1 / PREOPANC-2 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Germline testing
- For my situation (germline testing), which of the standard options do you recommend and why?Why: Guideline options include: Offered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance.
Follow-up
- For my situation (follow-up), which of the standard options do you recommend and why?Why: Guideline options include: CA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease.
Any stage
- Are there clinical trials I could join, for example of A Study of the Efficacy and Safety of Adjuvant Autogene Cevumeran Plus Atezolizumab and mFOLFIRINOX Versus mFOLFIRINOX Alone in Participants With Resected PDAC, Study of Daraxonrasib (RMC-6236) in Patients With Resected Pancreatic Ductal Adenocarcinoma (PDAC), Autogene cevumeran, Daraxonrasib?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Half of patients never complete adjuvant chemotherapy; whether giving it first helps clearly resectable tumours is unproven”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Recurrence after a complete resection and full chemotherapy remains common, and no marker reliably identifies who is cured”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Resectable pancreatic ductal adenocarcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
16targets
2drugs
7companies
5pathways
2terms
11trials
7ideas
3people
6key papers
2Pancreatic cancer was thought to be immunologically inert because of its low mutation burden; this study showed that with the right vaccine platform its few neoantigens can still be targeted. It is the strongest human evidence so far that personalised cancer vaccines can generate durable, tumour-specific immunity, and it justifies the randomised trials now running in pancreatic cancer and melanoma. Benefit is not yet proven, because responders may simply have had more immunogenic tumours.
This trial introduced a patient-centred composite endpoint and a drug that remained the backbone of pancreatic cancer treatment for a generation. Its small survival gain also shows how low the bar was, which is the context for the FOLFIRINOX and MPACT trials that followed.
Latest papers
topQuery for this cancer: (TITLE:"Resectable pancreatic ductal adenocarcinoma" OR ABSTRACT:"Resectable pancreatic ductal adenocarcinoma" OR TITLE:"Resectable pancreatic cancer" OR ABSTRACT:"Resectable pancreatic cancer" OR TITLE:"Operable pancreatic cancer" OR ABSTRACT:"Operable pancreatic cancer" OR TITLE:"Early-stage PDAC" OR ABSTRACT:"Early-stage PDAC" OR TITLE:"Stage I to II pancreatic adenocarcinoma" OR ABSTRACT:"Stage I to II pancreatic adenocarcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Resectable pancreatic ductal adenocarcinoma, not a curated reading list.
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