LAUSR

We our study “ Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma. We first want to clarify that we are strong proponents of neoadjuvant treatment (NAT) use in pancreatic ductal adenocarcinoma (PDAC), even in patients with resectable disease. NAT not only increases recurrence ‐ free survival, but also reduces tumor size, margin and lymph node positivity, and rates of postoperative complications, which are significant barriers to adjuvant therapy. Dr Kawada makes a critical and much ‐ debated observation that response to NAT is associated with improved overall survival. Yet, it does not equate to cure — even when a complete pathologic response is achieved. 3 Pathologic response to NAT did not reach significance in our patient cohort; however, our analysis was focused on identifying risk factors for early recurrence, not overall survival. Our study instead highlights that the beneficial effects of NAT are lost in the 23% of patients who develop early recurrence. We and others have shown that early recurrent PDAC tends to localize to the liver, while late recurrent tumors occur locoregionally or metastasize to the lung. 4 A recent study by Dreyer et al. demon-strates that liver recurrent PDAC activates distinct signaling pathways when