# Personalizing Treatment for Pancreatic Ductal Adenocarcinoma: The Emerging Role of Minimal Residual Disease in Perioperative Decision-Making

## TL;DR

This paper explores how detecting minimal residual disease using circulating tumor DNA can help personalize treatment and improve outcomes for pancreatic cancer patients.

## Contribution

The paper highlights the emerging role of ctDNA in MRD detection for perioperative decision-making in pancreatic ductal adenocarcinoma.

## Key findings

- ctDNA shows strong potential for early detection of high-risk relapse in PDAC patients.
- MRD status can guide personalized adjuvant treatment and improve risk stratification.
- Prospective trials are needed to validate ctDNA for clinical implementation.

## Abstract

Despite curative-intent surgery, many patients with pancreatic ductal adenocarcinoma experience disease recurrence due to undetected systemic spread. Circulating tumor DNA provides a non-invasive approach to identify minimal residual disease and to detect patients at high risk of relapse earlier. Emerging evidence indicates that ctDNA has strong potential to guide personalized perioperative management and improved risk stratification. Extensive validation in well-designed prospective trials is necessary before transition to clinical implementation.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with poor long-term survival despite advances in surgical techniques, systemic therapies, and perioperative management. High rates of systemic recurrence following curative-intent resection suggest that many patients harbor minimal residual disease (MRD), microscopic tumor burden that persists postoperatively and remains undetectable by conventional diagnostic tools. Recent advances in liquid biopsy technologies, particularly circulating tumor DNA (ctDNA) analysis, alongside detailed characterization of the PDAC mutational landscape, offer a promising non-invasive approach for MRD detection. Emerging evidence indicates that MRD status can serve as a sensitive prognostic biomarker, identify patients at high risk of relapse, and guide personalized perioperative therapy, including optimization of adjuvant treatment. This review summarizes current knowledge on the biology and detection of MRD in PDAC, its implications for perioperative risk stratification and treatment decision-making, and discusses future directions for integrating MRD assessment into clinical practice to enable more precise, individualized patient management.