Background: Retrospective data suggest that neoadjuvant therapy in patients with resectable pancreatic cancer may improve the R0 resection rate and potentially survival. We examined the impact of neoadjuvant therapy on survival rates at a population level for patients with resected pancreatic adenocarcinoma. Methods: Treatment and outcome data were obtained from the Surveillance, Epidemiology and End Results (SEER) Medicare database for patients with pancreatic adenocarcinoma, who underwent a curative intent pancreatectomy from 2001-2007. Patients were stratified by treatment (neoadjuvant vs no neoadjuvant therapy). Kaplan Meier curves were constructed to analyze survival. Cox proportional hazards regression models with and without propensity score weighting were performed to determine the effect of neoadjuvant therapy and race on mortality while adjusting for age, gender, race, marital status, SEER site, urban/rural location, income, education, year of diagnosis, and Charlson Comorbidity Score. Results: 2608 patients were included. 58.4% (n=1523) were between age 66-75 and 41.6% (n=1085) were age 76 or older. 94% (n=2459) did not receive neoadjuvant therapy and 6% (n=162) received neoadjuvant therapy. Patients undergoing neoadjuvant therapy were 28% less likely to experience death at one year (HR 0.72; 95% CI, 0.53-0.97; p=0.03). There was also a trend towards a lower risk of death in this group at 2 years (HR 0.82; 95% CI, 0.66-1.01; p=0.07). Conclusions: Patients with pancreatic adenocarcinoma who underwent neoadjuvant therapy followed by resection had an improved one-year survival relative to patients who did not receive neoadjuvant therapy in this cohort. This effect may partially reflect the role of neoadjuvant chemotherapy in allowing for better selection of patients likely to benefit from surgery. To our knowledge this is the first population-based study that suggests an improved survival in patients with pancreas cancer undergoing neoadjuvant therapy prior to resection.