Advice needed on neoadjuvant vs adjuvant therapy

I had surgery prior to chemo and radiation as an attempt to biopsy the tumor was unsuccessful. My tumor was also on the tail of my pancreas. The surgeon felt confident that he could successfully remove the tumor utilizing laparoscopic/robotic surgical technique to perform a distal pancreatectomy and splenectomy. The surgery (May 2023 at MGH Boston) was successful and he was able to get clean margins. However, I was diagnosed with stage 3 adenocarcinoma with small and large vessel involvement and 6 out of 24 positive lymph nodes. Recovery from the surgery was relatively easy. I was 69 at the time. I did 6 months of chemo followed by 6 weeks of chemo/radiation. I am now 3 1/2 years cancer free. I'm assuming that MSK will be utilizing laparscopic/robotic surgery? Good luck to your Mom.

I would encourage you to connect with the Seena Magowitz Foundation's pancreatic cancer support groups. We have professional counselors and patients who can share their experiences and help families navigate these difficult decisions.
The fact that Memorial Sloan Kettering believes your mother's tumor can be removed, with no major blood vessel involvement, is encouraging. Surgery offers an opportunity that many pancreatic cancer patients never have.

You are at a major pancreatic cancer center, which is important. But you should feel comfortable asking every question before proceeding.

I agree with @mcharlesfrancis in that if it's resectable, and it seems to indicate this is so, they want to just remove it. I had a Stage 2 diagnosis, but my oncologist sent me through 12 rounds of Folfirinox, then the distal pancreatectomy and splenectomy, no adjuvant chemo. The biggest issue I have now relates to having no spleen, it's been difficult to adjust to all the steps to avoid illness. Folfirinox is a difficult undertaking. I don't know your mom's overall state of wellness.

@anne7573217 thanks for sharing your experience and I’m sorry to hear your recovery from the splenectomy has been hard. Do you feel the vaccines have not been that helpful and you have to be overly cautious not to get sick? How long has it been since your surgery?

My mom is very healthy in terms of being very active currently day to day but she does have a lung condition so I especially worry about pneumonia but thankfully she did the get pneumonia vaccine last year.

Wishing you healing.

@cazalia It's been almost a year,since surgery, and I am sure the vaccines are some good insurance, but they don't prevent influenza 100% and I've had colds that turned into bronchitis and pneumonia in the past, plus I do a lot of "dirty work", that is, yard work and I caretake a public park and I have pets so I am constantly washing out and bandaging a scrape, cut or bug bite. I also work a part time job as a theater usher and I can't stand wearing a mask while I am trying to talk to people. Glad your mom is healthy and I just read a New York Times story about how patients who are able to stay active have better outcomes. Best to you, and your mom.

@anne7573217 thank you for the additional info on your experience. My mom also loves doing yard work and has a dog so good things to think about. I hope your issues from the spleen removal are getting better. Thank you for your kindness sharing your experience. This community has been a wonderful resource both emotionally and for information.

Sending you healing energy ❤️‍🩹

@stevm congratulations for being 3.5 years cancer free! Thank you so much for sharing your story.

My mother will be getting it done laparoscopically but they did say it would be open only if necessary but hopefully that won’t be the case.

How long after surgery did you start chemo? That’s great to hear your surgery recovery went well

@cazalia My distal pancreatectomy and splenectomy was on May 17, 2023. I was discharged on May 19 a couple of days ahead of schedule. Getting up and moving was key to recovery from the surgery. I had a chemo port implanted on June 12 and started chemo on June 13. I won't whitewash the effects of the chemo but with a positive attitude, support from friends and family and some good fortune your Mom can do it. Skilled care at places like MSK will do all that they can to get her through. The infusion nurses are the best. Best of luck to her.

@stevm thanks so much for sharing your experience and for the positivity. We are definitely all trying to stay positive for her!

@cazalia, did your mom have surgery? How is she doing? How are YOU doing?