This study tests a surgical treatment for patients with pancreatic cancer that has spread only to a few spots in the liver or lungs. *All patients* will receive the same treatment and must be on a specific chemotherapy called **NALIRIFOX** before surgery. This chemotherapy is a combination of drugs that help shrink tumors before they are removed. If the cancer worsens during or after the chemotherapy, the patient will be removed from the study. If the cancer stays the same or gets smaller, doctors will check if the main tumor can be safely removed. If it can, surgery will occur 2-6 weeks after finishing chemotherapy. If it cannot, more chemotherapy will be given. During surgery, doctors will try to remove both the main and small tumors. If the main tumor cannot be removed during surgery, the patient might receive more chemotherapy afterward. **Key Points:** - Length: Surgery is planned 2-6 weeks after chemotherapy if tumor is removable. - Visits: Multiple hospital visits for chemotherapy and surgery. - Risks: If cancer worsens with chemotherapy, patient exits study. Participants must be 18 or older, capable of consenting, and meet specific medical criteria.