I have to say I am a bit surprised by the 30-40% who opt out of surgery. I think for all of us we just want to get to surgery, thinking that is our only chance to beat this. But clearly, with such high recurrence rates we know that is not the case. I opted for Truty surgery. Same as your wife. Locally advanced stage III with vein involvement. Opting out never crossed my mind. And yes, Truty is very frank about quality over quantity of life. I had surgery July 24, 2023. My pre surgical scans showed no active tumor and my CA19 was 12. I have to say I have definitely questioned if I made the right decision. Recovery was rough, and battling diabetes and Creon and daily GI issues has been extremely difficult for me. I was diagnosed at age 39. Surgery at 40. And in very good shape, physically. I met 3 other women having surgery with Truty last year, and they have all 3 had recurrences. We are currently watching lung nodules in my scans. I am not sure what I meant when posting this. I just want to say it is a very difficult decision to make. And absolutely will affect quality of life. But to me, it is LIFE. I have 2 kids in elementary school, so quantity over quality was my goal. I am 9.5 months out from surgery, and each day is better. I am back to running and lifting weights. And the GI stuff cant take years to balance out. I pray daily that I have those years in me. Best of luck to you and your wife, whatever decision is made.