For resectable pancreatic cancer, what is a key determinant of survival?

• A. Adjuvant chemotherapy
• B. Radiation therapy
• C. Complete surgical resection with negative margins and absence of distant metastasis
• D. Tumor size

Answer: (C)

In resectable pancreatic cancer, survival is driven most by whether the tumor can be removed completely and whether the disease has spread beyond the pancreas. A complete surgical resection with negative margins means there are no cancer cells at the edges of the removed tissue (an R0 resection), which provides the best chance to control the disease locally. Equally crucial is the absence of distant metastasis; if cancer has already spread, removing the primary tumor won’t yield long-term cure, and survival is limited despite a clean local operation.

Adjuvant chemotherapy can improve outcomes after a complete resection, and radiation therapy may help in certain situations, but these factors cannot overcome the prognosis established by positive margins or systemic spread. Tumor size by itself is not as reliable a predictor of survival as the combination of achieving negative margins and absence of metastasis.