Background  Neoadjuvant therapy is expected to improve the prognosis of pancreatic cancer, but its application in resectable pancreatic cancer is still controversial.

  Objective  To evaluate the safety and efficacy of neoadjuvant therapy for resectable pancreatic cancer.

  Methods  A retrospective propensity score-matched case-control study was conducted in 60 pancreatic cancer patients who underwent radical resection in the Department of Hepatobiliary and Pancreatic Surgery of the Second Affiliated Hospital of Zhejiang University School of Medicine from March 2015 to July 2021. Preoperative neoadjuvant therapy (neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy with 3-8 cycles) was carried out in 20 cases as the neoadjuvant therapy group, and 40 patients were in the direct surgery group. The efficacy of neoadjuvant therapy was evaluated, and clinical outcomes of the two groups were compared, and the disease-free survival (DFS) data of the two groups were analyzed by Kaplan Meier curve and log-rank test.

  Results  The baseline of the two groups was comparable. The patients in the direct operation group had more preoperative jaundice (32.5% vs 0, P=0.011), higher preoperative bilirubin level (median 16.2 μmol/L vs 8.6 μmol/L, P＜0.001), and the time from diagnosis to operation was significantly shorter than that in the neoadjuvant therapy group (14.14 days vs 86.70 days, P＜0.001). After neoadjuvant therapy, BMI, tumor diameter, tumor markers and other characteristics showed certain downward trends, but there was no statistically significant differences(all P＞0.05). The pathological evaluation showed that there were 3 cases achieving pathologic complete response, and the overall response rate to neoadjuvant therapy was 60%; Radiological evaluation showed eight cases (40%) achieved partial response, 12 cases stable disease, and no serious adverse reactions of grade 3 or above were observed after neoadjuvant therapy. There was no significant difference in intraoperative parameters, postoperative complications, secondary operation rate, mortality, hospital stay, the rate of postoperative adjuvant chemotherapy and the time from operation to adjuvant chemotherapy between the two groups (all P＞0.05). Postoperative pathology results showed that there was no significant difference in tumor diameter, tumor differentiation, T stage, R0 resection rate, positive rate of lymph nodes, and the number of positive lymph nodes between the two groups (all P ＞0.05). There was no significant difference in median DFS between the two groups (12 months vs 12 months, P=0.878).

  Conclusion  Neoadjuvant therapy for resectable pancreatic cancer does not increase the risk of intraoperative risk and postoperative complications. It shows good safety, but has not achieved significant local and long-term survival benefits, which is suggested in patients with high risk of recurrence and metastasis.