Ellis RJ, Ho JW, Schlick CJR, et al. - Researchers sought to report on the utilization of upfront chemotherapy management of stage I pancreatic cancer. In addition, they investigated factors correlated with the use of upfront chemotherapy and subsequent resection and evaluated the hospital-level variability in upfront chemotherapy and subsequent resection. From the National Cancer Database, they assessed 17,495 patients; of these, 26.6% were receiving upfront chemotherapy. Patients who were ≥ 80 years of age, had T2 tumors, or were treated at a low-volume center were more likely to receive upfront chemotherapy. Only 33.5% of patients receiving upfront chemotherapy underwent subsequent resection. This indicates relatively low rates of surgical resection after upfront chemotherapy, and there was considerable variation in the proportion of patients who eventually undergo resection between hospitals. Based on findings, they recommend considering the use of surgery after upfront chemotherapy in resectable pancreatic cancer as an internal quality-of-cancer-care measure.