Primary tumor resection and lymph node dissection improve survival in de novo metastatic pancreatic ductal adenocarcinoma: an inverse probability of treatment weighting analysis

Pancreatic ductal carcinoma (PDAC) represents the fourth leading cause of cancer-related mortality worldwide (1). Surgery remains the only treatment option with the potential of cure for PDAC, and only a subset (20–30%) of patients have diseases at a locally resectable stage (2). Once distant metastases have occurred, only palliative chemotherapy or chemoradiation therapy is recommended by the guidelines (3). Despite progress in the treatment of metastatic PDAC (mPDAC), the prognosis remains dismal, with a median survival of only 8–11 months, even for patients receiving intensive chemotherapy with nab-paclitaxel/gemcitabine or FOLFIRINOX (4)