I see you have already received some very helpful and insightful replies. Just wanted to say your story sounds similar to mine, in many aspects. Diagnosed just shy of 40 with a 6 and 9 year old in 2022. Healthy, ran a couple half marathons, no risk factors or family history. Had mild upper abdominal and back pain. CA-19 at diagnosis was 174. First deemed borderline resectable, then non-resectable by a local surgical oncologist (with very little experience!). The neo-adjuvant chemo vs surgery first is debatable. Had I been offered surgery first (especially at a facility such as MSK), I likely would have done it. Just because the constant fear and anxiety of the cancer spreading during chemo/prior to surgery was very overwhelming. However, I would absolutely recommend adjuvant chemo, even with clean margins and clear lymph nodes! Good luck to you!