mbcfl - For what it's worth.... Similar to you, I was recently (May 2023) diagnosed with Stage 1b adenocarcinoma at the head/neck of my pancreas. At that time I had a CA19.9 high of 641 and some limited tumor entanglement with major venous blood vessels. Following treatment with Folfirinox (4 cycles) I switched to a Gemcitabine/Abraxane regimen due to severe reaction to Folfirinox. My last infusion of Gem/Abrax was 3 days ago. My most recent CT Scan (3 weeks ago) shows some small shrinkage of tumor and a most recent CA19.9 level of 55 three days ago. My plan, as recommended by Mayo Clinic - Rochester, is to return there (I reside in Alaska) in one week for further exams, 3-4 weeks of radiation therapy with reduced dose IV Gemcitabine, followed by a 4 week break. I anticipate having the Whipple in early January led by a very experienced surgeon and team at Rochester who will do the surgery robotically. (It's unclear to me what criteria was used to have me lined up with a Mayo surgeon who only does Whipples robotically versus another experienced Mayo surgeon who only does Whipples with open surgery. IMHO there are good arguments for each method.)

I share your concerns about the best treatment route to follow, especially given the ongoing debate among pancreatic oncologists and surgeons about the preference for surgery first, followed by adjuvant chemo vs. neo-adjuvant chemo/radiation followed by surgery. I am especially concerned about post-surgical reoccurrence of cancer months later. It seems somewhat of a crapshoot no matter which treatment plan we follow.

Good luck to you says this 75 year old guy.