Pancreatic cancer is a highly fatal malignancy with overall 5-year survival of under 10%, within the context of increasing incidence rates worldwide (Clin Gastroenterol Hepatol 2020 Mar 5. pii: S1542-3565(20)30276-7 [Epub ahead of print]). Even among the minority of patients who are diagnosed with early stage disease and undergo resection, most survive less than 5 years (short-term survivors (STS), however a unique subset of patients survive >5 years post-surgery coined long-term survivors (LTS) (Clin Cancer Res 2015;21:1944-1950). Recent human and mice studies suggests that the gut microbiome may play a role in pancreatic cancer initiation and progression through immune system modulation (Cancer Discov 2018;8:403-416, Gastroenterology 2018;155:33-37). Intramural bacteria can also be detected within pancreatic tumor tissue and predict sensitivity to systemic cancer therapy (Science 2017;357:1156-1160). Riquelme et al. addressed this topic in work conducted at the University of Texas MD Anderson Cancer Center (MDACC) and Johns Hopkins Hospital (JHH) to study the association between tumor microbiome and survival using the pancreatic tumor microbiome of LTS vs. STS (Cell 2019;178:795-806).Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.