Survival outcomes in localized pancreatic cancer treated with neoadjuvant chemotherapy (NAC).

683 Background: There is uncertainty about whether chemotherapy administered perioperatively or only in the adjuvant setting leads to the best survival outcomes in localized pancreatic cancer. Our tertiary care university-based practice favors NAC for the majority of eligible patients (pts). We performed a retrospective analysis to analyze outcomes in pts with resectable (R) and borderline resectable (BR) disease, and present analysis of overall survival (OS) and disease-free survival (DFS). Methods: Surgical candidates with R and BR pancreatic adenocarcinoma who were candidates for treatment from 2017-2023 were included. Resectability was determined by standard criteria and multi-disciplinary tumor board. OS and DFS were calculated using Kaplan-Meier analysis and log-rank tests. Results: 91 pts were included and started on NAC, 44 with resectable and 47 with BR disease. 56 pts underwent surgery while 35 (13 R, 22 BR) did not undergo surgery due to progression of disease, decline in functional status, or pt decision. Those that did not undergo surgery had a significantly worse DFS of 7 months compared to 18 months for those who underwent resection (p=