Beyond Survival: Unraveling Prognostic Determinants in Post-Treated Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma remains one of the most aggressive solid tumors, and prognosis after neoadjuvant treatment and surgery is highly variable. This thesis investigates prognostic determinants in post-treated pancreatic ductal adenocarcinoma beyond simple survival metrics, with the aim of improving surgical decision-making, pathological assessment, and postoperative risk stratification. The work is organized into three studies addressing the timing of surgery after neoadjuvant therapy, intraoperative management of the pancreatic neck margin, and the morphologic and biologic features of residual tumor after resection. Taken together, these studies show that prognosis in post-treated pancreatic ductal adenocarcinoma is shaped by a combination of treatment pathway, surgical factors, and tumor biology rather than by a single variable. These findings support a biologically informed approach to surgical timing and margin assessment and highlight the value of detailed pathology-based features, particularly intratumoral heterogeneity, in refining prognostic evaluation after neoadjuvant therapy.