The prognosis of pancreatic cancer is extremely poor, and surgery remains the only means of curing it. However, the vast majority of pancreatic cancer patients develop recurrence and metastasis within one year after surgery, and the percentage of long-term survival after surgery is very low, with a 5-year survival rate of no more than 20%. Studies have shown that the preoperative screening of suitable patients for surgery and the rational application of comprehensive perioperative treatment play a crucial role in improving the efficacy of surgery and prolonging the long-term survival of patients. The research team led by Professor Yu Xianjuan of the Department of Pancreatic Surgery, Fudan University Pancreatic Tumor Institute/Fudan University Cancer Hospital, has conducted a series of studies to improve the efficacy of pancreatic cancer surgery. Starting from the most routine and easy-to-use serological indicators, the team confirmed the superiority and importance of preoperative CA125 and CA19-9 in determining the resectability of pancreatic cancer (J Gastrointest Surg. 2013), which provided the most basic basis for screening the appropriate population for surgery. On this basis, the team further suggested that patients with preoperative pancreatic cancer with “CEA+/CA125+/CA19-9 ≥ 1000U/ml” serologic characteristics would not benefit from surgery by comparing the surgical population with the non-surgical population and systematically analyzing the clinical situation (Int J Cancer. 2015). In contrast, the surgical population that excluded such characteristics could benefit better from the surgery. At the same time, the team reasonably combined high-end functional imaging (PET/CT) and computerized 3D synthesis technology, and concluded that preoperative Metabolic Tumor Burden (MTB) is significantly superior in predicting surgical outcomes and can guide the development of pancreatic cancer treatment strategies (Eur J Nucl Med Mol Imaging. 2014). Preoperative population screening is an important guide for the development of comprehensive perioperative treatment strategies for pancreatic cancer. In the process of screening the population for surgical benefit, we identified some populations that could not benefit from surgery. The presence of potential micrometastases is the crux of the problem in this group, and the slow recovery from surgical trauma causes delay in the follow-up systemic therapy, which further affects the long-term survival of patients after surgery. This provides a clinical rationale for preoperative systemic treatment, i.e. neoadjuvant therapy, to improve the surgical outcome in this population. Neoadjuvant therapy is widely used in breast and colorectal cancers and has the following advantages: 1. Neoadjuvant therapy can enable Borderline resectable population to obtain surgical resection, reduce the rate of positive margins, and improve the radicality of surgery; 2. Neoadjuvant therapy can inhibit tumor cells in circulating blood, reduce the formation of preoperative micrometastases, and screen out Neoadjuvant therapy can suppress tumor cells in circulating blood, reduce the formation of preoperative micrometastases, and screen out a group of pancreatic cancers that are indeed in the limited stage, thus maximizing the efficacy of surgery; 3. Based on the above rationale and the emergence of more effective systemic treatment options for pancreatic cancer, neoadjuvant therapy is now a hot research topic in pancreatic cancer. The article presented here is titled Neoadjuvant Chemotherapy Generates a Significant Tumor Response in Resectable Pancreatic Cancer Without Increasing Morbidity and was published in Annals of Surgery. Corresponding author of the article is Pierre-Alain Clavien, president of the Euro-African Pancreatic Hepatobiliary Association, who has done excellent work in neoadjuvant therapy for pancreatic cancer. He previously confirmed the safety and feasibility of neoadjuvant chemotherapy in pancreatic cancer with a study published in J Clin Oncol, and the current study builds on these studies to explore the analysis of indicators for evaluating the efficacy of neoadjuvant chemotherapy. These research works have very good guidance for our exploration in neoadjuvant therapy. This study was established on the basis of a phase II clinical trial (J Clin Oncol. 2008) that included 28 patients with resectable pancreatic head cancer who underwent four cycles of neoadjuvant chemotherapy (gemcitabine + cisplatin) after preoperative baseline staging evaluation. Only two of these patients were lost to surgery after re-staging evaluation suggestive of new distant metastases, while the remaining 26 patients underwent surgical treatment with pancreaticoduodenectomy. The mean postoperative hospital stay was 16 days, the mortality rate was 0% in the first month after surgery, and the majority of patients had low-grade postoperative complications (grades I and II), making pancreaticoduodenectomy after neoadjuvant therapy safe. The prediction of the efficacy of neoadjuvant chemotherapy is an important guide for the selection of the timing of subsequent surgical intervention. In this study, the efficacy of neoadjuvant chemotherapy was evaluated in terms of SUVmax on histopathology, serology CA19-9 and functional imaging PET/CT. The investigators confirmed that neoadjuvant chemotherapy induces histopathological response, CA19-9 response, and SUVmax metabolic response in pancreatic cancer. Among them, the histopathological response is the gold standard for assessing the efficacy of neoadjuvant chemotherapy, however, this requires repeated punctures to obtain sufficient specimens. However, this is still difficult for pancreatic cancer where punctures are prone to adverse complications such as pancreatic leakage and pancreatitis. Therefore, there is an urgent need to find some clinical indicators that can predict the histopathological response. The investigators went on to analyze the feasibility of CA19-9 and SUVmax to predict histopathologic response. The investigators confirmed that preoperative baseline SUVmax, but not CA19-9, predicted histopathologic response. Therefore, the investigators concluded that changes in SUVmax during neoadjuvant chemotherapy can assess the efficacy of neoadjuvant chemotherapy and thus guide the timing of surgical intervention.