Despite various treatment strategies, the incidence and mortality of pancreatic cancer (PC) are among the highest for malignant tumors. Furthermore, there is a lack of effective molecular typing and targeted therapy to treat PC subtypes.

Multiplex immunofluorescence experiments were performed to explore the roles of FAM111B, FANCD2, KRAS and TP53 in human PC tissues. Kaplan-Meier survival curves were generated and a nomogram was prepared for prognostic prediction. Protein correlations were analyzed using human PC tissues and TCGA and GEO data. Pathways analysis, immunoanalysis, and drug susceptibility analysis were performed based on information in the TCGA database.

Our results indicate that expression of FAM111B and FANCD2 is correlated in human PC tissues and comprises a dual expression signature with predictive value for the prognosis of PC. Using information in public databases, we confirmed the oncogenic relevance of FAM111B and FANCD2 in PC and identified a positive correlation between FAM111B, FANCD2, TP53 and KRAS.FAM111B and FANCD2 jointly regulate ferroptosis, mitotic nuclear division, and nuclear division pathways. Both proteins were demonstrated to be positively correlated with markers of CD4 + Th2 cells and PD-L1 in the tumor microenvironment. Furthermore, drug sensitivity analysis suggested that patients with high FAM111B or FANCD2 expression were highly sensitive to chemotherapeutic and targeted drugs, indicating that these proteins may serve as predictors of treatment efficacy.

Elevated dual expression of FAM111B and FANCD2 is indicative of poor prognosis, alters the immune microenvironment, and exhibits sensitivity to certain therapeutic agents. Consequently, the high FAM111B/FANCD2 expression subtype may represent a novel and distinct phenotype of PC.

Identification of early predictors of postoperative pancreatic fistula (POPF) related postpancreatectomy hemorrhage (PPH) on contrast-enhanced computed tomography (CT) may help tailoring management after pancreaticoduodenectomy (PD) although no model has been validated so far.

A bicentric analysis of consecutive PD performed between 2017 and 2022 was performed. A recently reported CT-based score (CTS) was externally validated. Sensitivity refinements were proposed through a modified-CTS which was internally (development cohort, n=182) and externally validated (validation cohort, n=62). Bootstrap corrected Areas under the curve (AUCs), Sensitivity (Se) and Positive Predictive Value (PVV) were used to evaluate and compare the two scores.

A total of 244 patients (55.1% women; median age: 68 years [IQR: 58.0-75.0], clinically relevant (cr)-POPF: 25.4%, cr-PPH: 13.9%) were included. CTS accurately predicted a cr-PPH with an AUC of 0.83 (1000-boostrap 95% CI: 0.76-0.89). The modified-CTS, made available online (https://stylianostzedakis.shinyapps.io/pph_risk_calculator/), included CTS with 2 supplementary variables selected from a multivariable backward-stepwise regression: Perianastomotic air bubbles, posterosuperior pancreaticojejunal (PJ) anastomosis collection, posterior PJ defect, PJ collection in contact with hepatic or gastroduodenal artery stump and arterial wall irregularities. When compared with the CTS, although modified-CTS AUC [95%CI] were similar in the validation cohort (0.81 [0.62-0.95] vs. 0.87 [0.56-0.96], DeLong p=0.7), Se and PPV for early PPH detection were significantly higher (0.82 [0.75-0.92] vs. 0.71 [0.35-0.75] and 0.95 [0.83-0.99] vs. 0.33 [0.12-0.62], McNemar's p = 0.03).

With a robust prediction model, early CT-scan after PD seems a valid tool for early identification of high-risk cr-PPH patients.

Postoperative morbidity and mortality rates from pancreaticoduodenectomy (PD) have significantly decreased, allowing for greater consideration of patients with severe comorbidities. This study aimed to evaluate the effect of previous coronary artery intervention on morbidity and mortality among patients who underwent PD.

Patients who underwent PD were identified from the American College of Surgeon National Surgical Quality Improvement Program database. Patients with previous coronary artery intervention received either balloon dilatation or stent placement. The main outcome measures included in-hospital mortality and postoperative myocardial infarction (MI).

Of 10,848 patients who underwent PD, 698 (6.4%) received previous coronary artery intervention. Compared with patients without coronary artery intervention, those with previous coronary artery intervention were older (65 vs 70 years, respectively; P <.001), were less likely to be female (50.2% vs 26.4%, respectively; P <.001), and had higher median body mass index (26 vs 27 kg/m2, respectively; P =.003). Compared with patients not in the angioplasty/stent cohort, those in the angioplasty/stent cohort were more likely to have diabetes mellitus (22.0% vs 39.3%, respectively), functional impairment (2.4% vs 4.9%, respectively), chronic obstructive pulmonary disease (4.1% vs 8.2%, respectively), hypertension (51.2% vs 86.2%, respectively), and bleeding disorders (2.2% vs 8.0%, respectively) (all P <.001). Compared with patients not in the angioplasty/stent cohort, those in the stent/angioplasty group were more likely to have postoperative complications (41.0% vs 51.4%, respectively; P <.001). Previous stent/angioplasty procedure (odds ratio [OR], 2.61 [95% CI, 1.42-4.57]; P =.001) was associated with developing postoperative MI but was not an independent predictor of in-hospital mortality (OR, 1.19 [95% CI, 0.81-1.70]; P =.369).

Previous stent placement/angioplasty was not associated with increased in-hospital mortality in patients who underwent PD, despite being correlated with an increased risk of MI and severe complications. Previous coronary artery angioplasty and/or stenting is not an absolute contraindication for PD, but patients should be medically optimized preoperatively to mitigate the risk of major adverse cardiac events.

This study created a nude mouse model to study pancreatic cancer recurrence. Circumstances leading to the highest recurrence rates after curative surgery were also analyzed.

A total of 135 nude mice were divided into 3 groups: sham, metastasis, and resection (45 mice in each group). In sham and resection groups, AsPc-1 cells suspended in a synthetic extracellular matrix were injected into the tail of the pancreas of each mouse. In the metastasis group, cells were injected into the spleen. After 3 weeks, the resection group underwent distal pancreatectomy and the metastasis group underwent diagnostic laparotomy to confirm metastasis. To assess disease recurrence, the resection group was monitored weekly using luminescence imaging. Diagnostic exploration was conducted 3 weeks after surgery. Recurrence rate was evaluated and histological examination was performed for the resection group.

Among 45 mice, 43 developed cancerous masses in the tail of the pancreas without invading adjacent organs 3 weeks after the initial orthotopic injection. Of those 43 mice, one died due to intraoperative bleeding during complete surgical resection. Pancreatic cancer recurrence was observed in 37 of 42 mice (88.1%) at an average of 21.8 ± 2.2 days. Histological examination showed high nuclear pleomorphism and neoangiogenesis.

We developed an efficient model that could demonstrate recurrence after complete resection of pancreatic cancer. By confirming that recurrence occurs after surgery using this protocol, our model is expected to contribute to the development of various treatment strategies.

Preoperative biliary drainage (PBD) and antibiotic therapy due to cholangitis contribute toward bile contamination with multidrug-resistant organisms (MDROs) and increase the risk of infectious complications. However, little is known about the impact of MDROs in bile on postoperative outcomes and long-term survival in patients with periampullary malignancies. This retrospective single-center study investigated the impact of bile contamination with MDROs on the incidence, postoperative outcomes, and long-term survival in periampullary malignancies in a German tertiary pancreatic center between 2011 and 2015. A total of 428 patients underwent curative and palliative surgery for periampullary malignancies. At least one multidrug-resistant organism in bile was detected in 72 cases (16.8%). Patients with MDROs were significantly older, had a higher frequency of PBD, preoperative antibiotic therapies, non-standard single-shot antibiotics perioperatively, and prolonged antibiotic therapy postoperatively as opposed to the non-MDRO group. The incidence of surgical site infection was significantly higher in the MDRO group. Survival in papillary cancer was significantly worse in the MDRO group compared to the non-MDRO group. Patients with postoperative sepsis had significantly higher risk (hazard ratio 4.59) for postoperative death. Bile contamination with MDROs is associated with a significant increase of surgical site infection, leading to high mortality and poor long-term survival. Tailored antibiotic therapy may improve the survival rate.

The management of postoperative fluid collections, which refers to the accumulation of fluid in the peritoneal cavity following pancreaticoduodenectomy, presents significant challenges. However, ultrasonography has emerged as a promising tool for diagnosing and guiding interventions for this condition. Ultrasonography offers several advantages, including accessibility, cost-effectiveness, and real-time imaging capabilities. It plays a crucial role in identifying ascitic fluid collections, characterizing their contents, and evaluating the severity of fluid collections. Moreover, ultrasound guidance enhances the safety and effectiveness of placing abdominal catheters. The aim of this study is to assess the diagnostic utility of ultrasonography in postoperative fluid collections following pancreaticoduodenectomy and evaluate the clinical efficacy of ultrasound-guided abdominal catheter placement.

A total of 309 hospitalized patients underwent postoperative pancreaticoduodenectomy, with 171 patients undergoing laparoscopic pancreaticoduodenectomy (LPD) and 138 patients undergoing open pancreaticoduodenectomy (OPD), as assessed by ultrasonography. We examined the abdominal cavity for the presence of postoperative fluid collections and evaluated the site of postoperative fluid collections and the necessity for tube drainage. In cases where an abdominal indwelling catheter was required, we observed the location of postoperative fluid collections, performed echocardiography, and analyzed the characteristics of drainage fluid. We conducted a comparative analysis of short-term postoperative outcomes between LPD and OPD, encompassing hospitalization duration, fever duration, presence or localization of postoperative fluid collections, number of abdominal indwelling catheters used, location of abdominal drainage fluid collection, and time until postoperative catheter removal.

The LPD group demonstrated a significantly lower incidence of postoperative fluid collections compared to the OPD group, as determined by ultrasonography (39.2% vs. 59.3%, p = 0.001). Additionally, the LPD group had shorter hospital stays (16 [13, 21] vs. 21 [17, 28] days; p < 0.001), reduced duration of fever (1 [0, 3] vs. 3 [1, 5] days; p < 0.001), faster time to postoperative catheterization (7 [5, 10] vs. 8 [6, 13] days; p < 0.001), fewer required tubes (0 [0, 1] vs. 1 [0, 1]; p < 0.001), and shorter extubation time (7 [5, 9] vs. 9 [5, 12] h; p < 0.001) compared to the OPD group. There were correlations observed between the two groups regarding postoperative fluid collections, ultrasound sound transmission, separation of postoperative fluid collections, and traits of drainage fluid. However, there were no significant differences between the two groups in terms of postoperative fluid collections location (dissociative or restrictive), ultrasound sound transmission (excellent or poor), and separation of postoperative fluid collections (no separation, less separation, and more separation).

Postoperative fluid collections is a commonly encountered concurrent condition following pancreaticoduodenectomy. Ultrasonography allows for the observation of diverse characteristics related to postoperative fluid collections, including its precise localization, sound transmission properties, and the presence of internal separations. Moreover, it enables timely guidance for precise placement of drainage tubes.

Background and Objectives: The pancreas receives blood through a complex network of multiple branches, primarily originating from the celiac trunk (CeT) and the superior mesenteric artery (SMA). This blood supply is structured into three main arterial groups, each serving different regions of the pancreas to effectively support its endocrine and exocrine functions. Materials and Methods: The databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and the Caribbean Literature in Health Sciences (LILACS) were searched until January 2025. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of sixteen studies met the established selection criteria in this study for meta-analysis. Pancreatic irrigation variants presented a prevalence of 11.2% (CI: 7-14%) and a heterogeneity of 88.2%. The other studies were analyzed by subgroups, showing statistically significant differences in the following subgroups: (1) sample type-a larger sample of images analyzed in the included studies (p = 0.312), which did not show statistically significant differences; (2) geographical region (p = 0.041), which showed a greater presence in the Asian population studied, and this was statistically significant; and (3) sex (male or female) (p = 0.12), where there were no statistically significant differences. Conclusions: The discovery of variations in pancreatic irrigation is common due to the numerous blood vessels involved in supplying this vital organ. Understanding different vascular patterns (such as those from the splenic and mesenteric arteries) is crucial for surgical interventions on the pancreas. For transplant patients, a thorough vascular analysis of both the donor and recipient is essential. Variations can impact blood flow and compatibility, potentially leading to transplant rejection if not addressed. To enhance outcomes, it is recommended to develop more accurate imaging tools for pre-surgical analysis, necessitating ongoing research in this area.

Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this concept remains poorly defined, both embryologically and anatomically. Our objective was to establish a clear embryological and anatomical definition of the mesopancreas, making anatomical data more applicable in surgical practice. Methods: We examined seven cadavers (5 males, 2 females, aged 62-71) with no medical or surgical history, preserved in 9% formalin at Carol Davila University's Anatomy Department. Regional dissections were performed in successive planes, highlighting the celiac ganglia and the associated network of neural connections that comprise the mesopancreas. Results: Our study defines the "mesopancreas" as remnants of primordial mesenteries that coalesced into the Treitz fascia. We identified its functional components as nerve fibers linking the celiac ganglia and superior mesenteric plexus to the pancreas, along with vascular structures, lymphatics, and connective and adipose tissue. These components likely contribute to regional metastasis in pancreatic head cancer. While resection of the mesopancreas could help prevent metastasis, its complex anatomy and proximity to major vessels pose significant surgical challenges. Conclusions: Based on our findings, we propose a plausible definition for the term "mesopancreas". It encompasses the structures that originated as part of the primordial mesenteries, which subsequently coalesced, resulting in the formation of the Treitz fascia. In essence, the mesopancreas is the functional content of a former mesentery.

The intraoperative administration of corticosteroids has been shown to improve postoperative outcomes in patients undergoing surgery; however, the impact of corticosteroids on complications following pancreatoduodenectomy (PD) remains controversial.

This study aimed to evaluate the efficacy of perioperative corticosteroids on postoperative complications after PD.

A comprehensive search was conducted using the PubMed, Embase, and Web of Science databases for studies published prior to 1 July 2024. Of 7418 articles identified, a total of 5 studies were eligible for inclusion in this meta-analysis. The primary outcome was incidence of postoperative major complications (PMCs), while the additional outcomes were incidences of postoperative pancreatic fistulas (POPFs), infection, delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), bile leakage, reoperation, and 30-day mortality. The study was registered in the PROSPERO database (CRD42024524936).

Finally, 5 studies involving 1449 patients (537 with corticosteroids and 912 without corticosteroids) were analyzed. Intraoperative corticosteroids were not associated with any improvement in PMCs (p = 0.41). The incidence of POPF (p = 0.12), infectious complications (p = 0.15), or DGE (p = 0.81) were not significantly different between the two groups. No obvious differences were found in the incidence of PPH (p = 0.42), bile leakage (p = 0.68), 30-day mortality (p = 0.99), or reoperation (p = 0.26).

Perioperative corticosteroids did not significantly demonstrate any protective advantage in terms of postoperative complications after PD. This finding may serve as a reference for the perioperative use of corticosteroids in pancreatic surgery. Well-designed clinical trials are warranted in the near future in order to provide high-level evidence.

BackgroundShort-term outcomes after pancreatoduodenectomy (PD) are well-studied, but long-term reoperation rates and their indications remain poorly characterized.MethodsA single-center retrospective chart review was performed on patients who underwent PD for pancreatic adenocarcinoma between 1/2011 and 12/2021. Reoperations occurring >90 days after PD were dichotomized to being related or unrelated to the index PD or pancreatic adenocarcinoma. The Kaplan-Meier analysis estimated the incidence of long-term reoperation at 1 and 5 years postoperatively.ResultsSix-hundred twenty-eight patients were included. The 5-year incidence of any additional operation >90 days after PD was 30.0% (95% CI 23.2-36.2%), and the 5-year incidence of any long-term related reoperation was 21.2% (95% CI 15.0-26.8%). The most common indications for reoperations by 5-year incidence were cancer recurrence (12.8%, 95% CI 7.6-17.7%), incisional hernia (6.2%, 95% CI 2.6-9.7%), small bowel obstruction (1.3%, 95% CI 0.2-2.4%), and leak, fistula, or infection (1.0%, 95% CI 0.1-2.0%). Of the examined risk factors, only 90-day reoperation was found to be predictive of long-term related reoperations (P = 0.02). Additionally, the 5-year incidence of endoscopic or interventional radiology procedures was 20.2% (95% CI 14.5-25.4%). However, 40.9% (95% CI 33.6-47.3%) of patients required additional surgery or procedures of any kind between 90 days and 5 years after PD.DiscussionWithin 5 years of PD, one in three patients required additional surgery, and one in five had operations for related indications. Related reoperative indications included recurrence, hernia, PD-specific complications, and small bowel obstruction. However, the rates of each of these reoperations were relatively low.

Objective and accurate assessment of blood loss during pancreaticoduodenectomy (PD) is crucial for ensuring the safety and efficacy of the procedure. While the visual method remains the most common clinical metric, many scholars argue that it significantly differs from actual blood loss and is inherently subjective.

To assess blood loss in PD via delta hemoglobin (ΔHb) and compare it with the visual method to predict bleeding-related risk factors.

In this retrospective analysis, 1722 patients who underwent PD from 2017 to 2022 at Shandong Provincial Hospital were divided into three groups: Open PD (OPD), laparoscopic PD (LPD), and conversion to OPD (CTOPD). Intraoperative ΔHb (IΔHb) was calculated via preoperative and 72-hour-postoperative hemoglobin concentrations, and its association with visually obtained estimated blood loss (EBL) was analyzed. Perioperative ΔHb (PΔHb) was calculated via preoperative and predischarge hemoglobin concentrations. We compared the differences in IΔHb and PΔHb among the three groups, and performed univariate and multivariate regression analyses of IΔHb and PΔHb.

The preoperative general information of patients showed no statistically significant difference among the three groups (P > 0.05). The IΔHb in the OPD, LPD, and CTOPD groups were 22.00 (12.00, 36.00), 21.00 (10.00, 33.00), and 33.00 (18.12, 52.24) g/L, respectively; And the PΔHb in the OPD, LPD, and CTOPD groups were 25.87 (13.51, 42.00), 25.00 (14.00, 45.00), and 37.48 (21.64, 59.65) g/L, respectively, values significantly differed (P < 0.05). IΔHb and EBL were significantly correlated (r = 0.337, P < 0.001). The results of univariate and multivariate regression analyses indicated that American Society of Anesthesiologists (ASA) classification IV [95% confidence interval (CI): 2.330-37.811, P = 0.049] and preoperative total bilirubin > 200 μmol/L (95%CI: 2.805-8.673, P < 0.001) were independent risk factors for IΔHb (P < 0.05), and ASA classification IV (95%CI: 45.934-105.485, P < 0.001), body mass index > 24 kg/m2 (95%CI: 1.285-9.890, P = 0.011), and preoperative total bilirubin > 200 μmol/L (95%CI: 6.948-16.797, P < 0.001) were independent risk factors for PΔHb (P < 0.05).

There is a correlation between IΔHb and EBL in PD, so we can assess the patients' intraoperative blood loss by the ΔHb method. ASA classification IV, body mass index > 24 kg/m², and preoperative total bilirubin > 200 μmol/L increased perioperative bleeding risk.

We sought to determine the significance of age and frailty in predicting peri-operative outcomes of robotic pancreaticoduodenectomy (RPD).

Data from our institution's prospectively collected robotic pancreaticoduodenectomy database was analyzed for the years 2018-2023. The 5-factor modified frailty index (mFI-5) was used as a concise stratification tool for frailty. Predictive models for composite adverse event (CAE) variable were created using adjusted logistic regressions.

116 patients underwent RPD. Mean age of this cohort was 70.65 years (±11.44). The mean operative time was 311.47 min (±71.35) and the estimated blood loss was 107.07 mL (±128.49). The most common postoperative complications included in the CAE were pancreatic leak (n = 10, 8.62 %), delayed gastric emptying (n = 10, 8.62 %), bleeding (n = 5, 4.31 %), and atrial fibrillation (n = 2, 1.72 %). The 90-day mortality was 1.72 %. There was a gradual increase in the odds ratio of CAE with increasing mFI-5 score: OR 1.52 (95 % CI 0.25-9.20) for mFI-5 score of 1 and OR 31.92 (95 % CI 1.79-570.09) for mFI-5 score of 4 compared to score of 0.

Preoperative mFI-5 score may serve as a risk stratification tool for RPDs.

Pancreatic cancer (PaCa) patients face a 5-year survival rate of just 13%. Most patients present with unresectable disease and endure aggressive treatments with significant chronic and debilitating side effects. PaCa patients also experience significant unmet supportive care needs (e.g., physical, psychological, informational/educational); however, limited qualitative studies have explored the specific needs of racially and ethnically diverse PaCa populations.

This study identified supportive care needs in a racially and ethnically diverse sample of PaCa survivors.

As part of a larger project to develop a psychosocial symptom management intervention, semi-structured qualitative interviews were conducted with PaCa survivors to explore the supportive care needs at diagnosis and after treatment. Qualitative data were analyzed using Rapid Qualitative Analysis, and personal/medical characteristics were analyzed using descriptive statistics.

PaCa survivors (n = 18; Mage = 64) participated, with the majority identifying as female (66.7%), White (88.9%), and Hispanic (55.6%). Over one-third completed interviews in Spanish. Four themes emerged: (1) information/health system needs, including difficulty understanding complex medical concepts, limited holistic care, post-treatment symptom management, and health behaviors; (2) psychosocial needs related to quality of life and relationships with family and healthcare providers; (3) physical and functional needs, including persistent side effects and lifestyle changes; and (4) positivity and gratitude.

We emphasize the themes of unmet supportive care needs in a racially and ethnically diverse sample of PaCa survivors. These findings underscore the importance of developing interventions to address these gaps and improve the overall quality of life for diverse PaCa patients.

Pancreatic neuroendocrine tumors (pNETs) are a group of tumors with complex therapeutic options that differ according to pathological grading, clinical staging, and the existence of hormone secretion symptoms. We report a 34-year-old male with recurrent acute pancreatitis due to a non-functioning pNET. He presented with intermittent epigastric pain and elevated pancreatic enzymes. MRCP and endoscopic ultrasound revealed an oval lesion near the pancreatic head, confirmed as a grade 1 neuroendocrine tumor on biopsy. A Whipple procedure was performed based on tumor size and location. This case highlights the rare occurrence of pNET presenting with acute pancreatitis.

Background Intraoperative air leak test (ALT) is routinely used to check anastomosis of the stomach, small intestine, and rectum. Its advantage is that it repairs the leak at the same time, thus preventing postoperative complications and re-exploration. Method ALT was done by insufflating the stomach with air to check the integrity of gastrojejunal anastomoses (GJ); the same air was pushed into the afferent jejunal limb to distend it up to hepaticojejunostomy (HJ) and pancreaticojejunostomy (PJ), thus testing the leak at all three anastomoses. ALT was performed in 16 patients (group 1) and the results were compared with 52 patients (group 2) who underwent pancreatoduodenectomy (PD) without ALT, between August 2019 and December 2022. Results ALT revealed a GJ leak in two and an HJ leak in one out of 16 patients, all of which were repaired immediately. It did not reveal any PJ leak. No postoperative bile leak was seen in group 1, while postoperative bile leak was seen in five of 52 patients in group 2 on postoperative day (POD) 1. High drain fluid amylase in the left drain on POD 3 was present in 11 patients (69%) in group 1 and 30 patients (44%) in group 2. A right drain was removed two days earlier and a left drain one day earlier in group 1. Reintervention and 30-day mortality were higher in group 2. Hospital stay was shorter (7.4 versus 8.2 days) in group 1. Conclusion Intraoperative ALT identified an anastomotic leak from GJ and HJ but not PJ, facilitating its immediate repair, thus preventing serious postoperative complications following PD. Whether ALT has any role in the detection of a PJ leak needs further validation.

To evaluate the relationship between the muscle mass-to-fat ratio (MMFR) at the third lumbar spine (L3) and overall survival (OS) as well as related complications after pancreaticoduodenectomy (PD) for pancreatic cancer. Patients who underwent PD for pancreatic cancer between March 2017 and May 2023 at the Second Affiliated Hospital of Soochow University were included. Muscle mass and fat content at the L3 were measured by computed tomography. The specific formula that was used to calculate the MMFR was total abdominal muscle area/(subcutaneous adipose tissue area + visceral adipose tissue area), and the optimal cutoff values of the MMFR based on receiver operating characteristic curves were 0.688 for males and 0.382 for females. Patient characteristics were collected, and multivariate analyses were used to evaluate the impact of the MMFR on prognosis. Kaplan-Meier survival curves and log-rank tests were used to compare OS between the high-MMFR and low-MMFR groups. On the basis of the optimal cutoff values, 191 patients were divided into two groups, with 91 patients in the low-MMFR group and 100 patients in the high-MMFR group. The incidence of POPF was significantly greater in the low-MMFR group than in the high-MMFR group. According to multivariate analysis, the MMFR was an independent factor associated with POPF and OS. Patients with low MMFRs had significantly shorter OS and a greater POPF incidence than did those with high MMFRs. The MMFR is an independent predictor of POPF and affects the OS of patients undergoing PD for pancreatic cancer.

Postoperative pancreatic fistula (POPF) is the most severe complication after pancreaticoduodenectomy (PD), and this study investigates the effects of single-layer and double-layer pancreaticojejunostomy (PJ) on POPF.

Four electronic databases were systematically searched until March 2024: PubMed, Web of Science, Embase, and Cochrane Library. Statistical analysis was performed using Review Manager (RevMan) software. Mean difference (MD) or odds ratios (OR) with 95% confidence intervals (CI) were used to indicate continuous or dichotomous variables, respectively. Ten studies were included, comprising 1811 patients.

Compared to the double-layer PJ group, the single-layer PJ group had a similar POPF rate (OR=0.73; P=0.28) and grade C POPF rate (OR=0.55; P=0.12), but a lower grade B POPF rate (OR=0.50; 95% CI: 0.31-0.81; P=0.005). The clinically relevant POPF (CR-POPF) rate was lower in the single-layer PJ group (OR=0.47; 95% CI: 0.31-0.73; P<0.001), especially in the 2017 International Study Group of Pancreatic Surgery (ISGPS) criteria subgroup (OR=0.44; 95% CI: 0.27-0.73; P=0.001), the China subgroup (OR=0.41; 95% CI: 0.26-0.64; P<0.001), and the minimally invasive subgroup (OR=0.40; 95% CI: 0.22-0.74; P=0.003).

Compared with double-layer PJ, single-layer PJ after PD might reduce the incidence of CR-POPF.

Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy. We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.

The main symptoms included black stool, hematochezia, haematemesis, blood in the nasogastric tube, and hemorrhagic shock. The mean age was 66.25 years old and the median onset time was 340 d after the surgery. The bleeding location comprised gastrointestinal anastomosis, bile duct-jejunum anastomosis, and extraluminal bleeding. The possible causes included marginal ulcer, jejunal varix, and abdominal infection. Endoscopic hemostatic clips, as well as a covered stent using angiography, were utilized to stop the bleeding and three patients survived. Only one patient died of gastrointestinal bleeding, abdominal bleeding, abdominal infection, hypovolemic shock, and disseminated intravascular coagulation.

Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.

The pancreas, previously considered a sterile organ, has recently been shown to harbor its own microbiota that may influence tumor biology and patient outcomes. Despite increasing interest in the impact of the microbiome on cancer, the relationship between pancreatic tissue and oral microbiomes in pancreatic ductal adenocarcinoma (PDAC) remains limited. In this study, the oral and pancreas tissue microbiomes of patients with PDAC were compared to patients with other periampullary cancers (DC/AC) and a healthy control group using 16S rRNA gene sequence analysis. The results showed a significant reduction in microbial diversity in the saliva of cancer patients compared to healthy controls, while the PDAC patients exhibited a distinct microbial profile in their pancreatic tissues, consisting predominantly of Firmicutes, Proteobacteria, and Actinobacter, after filtering the microbiome of the indoor environment. Notably, the presence of oral bacteria such as Anoxybacillus, Clostridium, and Bacillus in pancreatic tissues suggests potential translocation from the oral cavity. This study emphasizes the importance of understanding the role of body fluid and tissue microbiota in pancreatic cancer, proposing that oral dysbiosis may contribute to disease progression. Moreover, the results suggest that the microbiome of the indoor environment in which samples are collected and analyzed is also important in microbiota analysis studies.

The purpose of this study was to analyze the publication characteristics and development of the International Journal of Surgery (IJS) over its 20-year history.

This study included articles published in IJS during the 20 years from 2004 to 2024. The data were analyzed using the Citespace, VOS viewer, and the 'Bibliometrix' package in R software. The authors studied the dynamics and trend patterns of IJS literature production through descriptive bibliometrics and identified the most prolific authors, publications, institutions, and countries. Bibliometric maps were utilized to visualize published articles' content and identify the most prolific research terms and topics in IJS , as well as their evolution over time.

A total of 5964 publications in the IJS from 2004 to 2023 and 356 publications in 2024 were included in the analysis. The study revealed a positive trend in literature production, although the number of articles published in IJS has slightly decreased recently. The most productive country was China ( n =1211), the most productive institution was Sichuan University ( n =151), and the most prolific author was Wang Yang ( n =87). The top 15 most cited articles focus primarily on research reporting standard guidelines for surgical studies. Research published in IJS mainly targeted middle-aged and older adults, emphasizing postoperative complications and treatment outcomes. The future research focus in IJS might center on integrating artificial intelligence and deep learning technologies to revolutionize surgical research and practice.

The International Journal of Surgery significantly contributes to advances in surgical research. IJS prioritized enhancing patient outcomes and advancing surgical techniques, focusing on middle-aged and older adults, postoperative complications, and treatment outcomes. The journal emphasized robust evidence through retrospective, controlled, and cohort surgical studies. Integrating artificial intelligence and deep learning represented a significant frontier poised to revolutionize surgical care, shaping the future landscape of research and practice.

Gastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients.

To analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission.

Retrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded.

Ninety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001).

In pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.

Postoperative complications are prone to occur in patients after radical pancreaticoduodenectomy (PD). This study aimed to construct and validate a model for predicting postoperative major complications in patients after PD.

The clinical data of 360 patients who underwent PD were retrospectively collected from two centers between January 2019 and December 2023. Visceral adipose volume (VAV) and subcutaneous adipose volume (SAV) were measured using three-dimensional (3D) computed tomography (CT) reconstruction. According to the Clavien-Dindo classification system, the postoperative complications were graded. Subsequently, a predictive model was constructed based on the results of least absolute shrinkage and selection operator (LASSO) multivariate logistic regression analysis and stepwise (stepAIC) selection. The nomogram was internally validated by the training and test cohort. The discriminatory ability and clinical utility of the nomogram were evaluated by area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA).

The major complications occurred in 13.3% (n = 48) of patients after PD. The nomogram revealed that high VAV/SAV, high system inflammation response index (SIRI), high triglyceride glucose-body mass index (TyG-BMI), low prognostic nutritional index (PNI) and CA199 ≥ 37 were independent risk factors for major complications. The C-index of this model was 0.854 (95%CI [0.800-0.907]), showing excellent discrimination. The calibration curve demonstrated satisfactory concordance between nomogram predictions and actual observations. The DCA curve indicated the substantial clinical utility of the nomogram.

The model based on clinical and CT indices demonstrates good predictive performance and clinical benefit for major complications in patients undergoing PD.

Pancreatic cysts (PCs) are increasingly detected through abdominal imaging, prompting exploration of alternatives such as endoscopic ultrasound-guided PC ablation due to the risks and costs associated with surgery. This study conducts a systematic review and meta-analysis of endoscopic ultrasound-guided PC ablation's short-term efficacy and complications for PC management.

A systematic review and meta-analysis were carried out on PubMed, Ovid, Cochrane, and TRIP electronic databases. The primary outcome was cyst resolution (partial and complete) and persistence on imaging 12 months after ablation. The secondary outcome was procedure-related adverse events.

Eight studies were eligible for analysis. Complete cyst resolution on imaging 12 months after endoscopic ultrasound ablation was 50% [95% CI 36‒63, I2 = 85.31%]. Partial cyst resolution was 27% [95% CI 15‒41, I2 = 87.07%], and cyst persistence was 17% [95% CI 11‒24, I2 = 62.11%]. The rate of complete resolution varied depending on the treatment agent (for ethanol 29% [95% CI 10‒53]; lauromacrogol 51% [95% Cl 36‒67]; ethanol and paclitaxel 63% [95% CI 48‒76]; paclitaxel and gemcitabine 67% [95% CI 45‒83]; and ethanol, paclitaxel, and gemcitabine 61% [95% CI 39‒80]). Postprocedure adverse events included abdominal pain in 4% [95% CI 0‒11], pancreatitis in 3% [95% CI 1‒5], and fever in 1% [95% CI 0‒3] of all patients.

The treatment of pancreatic cysts with endoscopic ultrasound ablation results in acceptable levels of complete resolution, and low incidence of severe adverse events. The effectiveness of this treatment is further enhanced when chemoablative agents are employed.

Pancreaticoduodenectomy has been the standard of care for managing duodenal neoplasms, but recent studies show similar overall and disease-specific survival after pancreas-preserving duodenectomy (PPrD) with potentially less morbidity.

Retrospective cohort of all adult (age >18) patients who underwent PPrD with curative intent of a neoplasm in or invading into the duodenum at our institution from 2011 to 2022 (n ​= ​29), excluding tumors involving the Ampulla of Vater or the pancreas. Statistical analyses were performed using STATA.

R0 resection was achieved in 93 ​% patients. Ten (34.4 ​%) experienced postoperative complications (13.7 ​% within Clavien-Dindo III-V). PPrD patients had lower rates of pancreatic leak, delayed gastric emptying, and deep surgical site infection.

In this case series, we demonstrate PPrD is safe and effective, with a high rate of complete resection and lower complication rate than that seen in pancreaticoduodenectomy.

Despite technical advances in recent decades and a decrease in hospital mortality (<5%), pancreaticoduodenectomy (PD) is still associated with major postoperative complications, even in high-volume centers. The present study aimed to assess the effect of a modified reconstruction technique on postoperative morbidity and mortality. A cohort study of all patients (n=218) undergoing PD between January 2010 and December 2019 was performed at Attikon University Hospital (Athens, Greece). Several variables were studied, including demographic data, past medical history, perioperative parameters, tumor markers and pathology, duration of hospitalization, postoperative complications, 30-day-survival, postoperative mortality and overall survival using multivariate logistic regression and survival analysis techniques. In this cohort, 123 patients [modified PD (mPD) group] underwent a modified reconstruction after a pylorus-preserving pancreaticoduodenectomy, which consisted of gastrojejunostomy and pancreaticojejunostomy on the same loop and an isolated hepaticojejunostomy on another loop. In the standard PD (StPD) group, 95 patients underwent standard reconstruction. The median age was 67 years, ranging from 25 to 89 years. Compared with in the StPD group, the mPD group had significantly lower rates of grade B and C pancreatic fistula (4.9% vs. 28.4%), delayed gastric emptying (7.3% vs. 42.1%), postoperative hemorrhage (3.3% vs. 20%), intensive care unit admission (8.1% vs. 18.9%), overall morbidity (Clavien-Dindo grade III-V: 14.7% vs. 42.0%), perioperative mortality (4.1% vs. 14.7%), and shorter hospitalization stay (11 days vs. 20 days). However, no difference was noted regarding median survival (35 months vs. 30 months). In this single-center series, a modified reconstruction after PD appears to be associated with improved postoperative outcomes. However, further evaluation in larger multi-center trials is required.

Surgical reconstruction is a crucial stage in various surgeries, including pancreaticoduodenectomy, as it can significantly affect the surgical results. The objective was to design a suture force feedback (SFF) device that can precisely measure the suture force during surgical closures. Afterward, the device was used to train junior surgeons in surgical closure techniques.

The SFF was used to capture the suture force data of experienced surgeons. This data was utilized to train and assess junior surgeons. The SFF device had 2 tactile-based force sensors that measured the applied force. Whenever the applied force was not within the optimal force range, the device provided feedback to the surgeon. A workshop was conducted to train junior surgeons in surgical closure techniques to improve their suturing skills.

Thirty-seven junior surgeons were enrolled in this training, of whom only 24 completed the 30-day training program. The pre-assessment results revealed that the force exerted by junior surgeons during suture knot-tying was uneven compared with that of the experienced surgeons, with a significant difference in the force exerted per knot throw (P = 0.005. Before the training program, junior surgeons applied a force of 3.89 ± 0.43 N, which was more than twice the force applied by experienced surgeons (1.75 ± 0.12 N). However, after completing the 30-day training program, their force improved to 2.35 ± 0.13 N.

The SFF device was shown to be an encouraging training tool for improving the surgical closure dexterity and technique of the participating junior surgeons.

Partial pancreatic resections are among the most complex surgical procedures in visceral tumor medicine and are associated with a high postoperative morbidity with a complication rate of 40-50 % of patients even in specialized centers.

Description of typical surgical resection procedures and the resulting postoperative anatomy, typical normal postoperative findings, common postoperative complications, and radiological findings.

CT is the most appropriate imaging technique for rapid and standardized visualization of postoperative anatomy and detection of clinically suspected complications after partial pancreatic resections. The most common complications are delayed gastric emptying, pancreatic fistula, acute pancreatitis, bile leakage, abscess, and hemorrhage. Radiologists must identify the typical surgical procedures, the postoperative anatomy, and normal postoperative findings as well as possible postoperative complications and know interventional treatment methods for common complications.

· Morbidity after pancreatic surgery remains high.. · CT is the best method for visualizing postoperative anatomy and is used for early detection of complications.. · Pancreatic fistula is the most common relevant complication after pancreatic resection.. · The ability of a center to manage complications is crucial to ensure the success of therapy..

· Fischbach R, Peller M, Perez D et al. The postsurgical pancreas. Fortschr Röntgenstr 2024; 196: 1037 - 1045.

The etiology and management of nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) remain unclear. This study aimed to investigate the risk factors and outcomes of NAFLD after PD (PD-NAFLD).

Patients who underwent PD at our institution between June 2019 and September 2021 were enrolled in the study. The clinical manifestations and outcomes of the patients with PD-NAFLD were evaluated. Multivariable analysis was used to identify risk factors for PD-NAFLD.

Of the 407 patients enrolled, PD-NAFLD was identified in 54 (13.2%). The median time of onset of PD-NAFLD was 72.5 (51.5-171.25) d postoperatively. Twenty-four patients (44.4%) recovered completely within 36 mo postoperatively. Adjuvant chemotherapy was administered in 147 malignant cases, and patients with PD-NAFLD encountered delay or discontinuation of chemotherapy more frequently than those without PD-NAFLD (55.9% versus 30.1%, P = 0.006). Multivariable analysis identified female sex, high body mass index, and neoadjuvant chemotherapy as independent risk factors for PD-NAFLD.

PD-NAFLD is a common complication of PD. Female sex, high body mass index, and neoadjuvant chemotherapy may be associated with the development of PD-NAFLD. PD-NAFLD may interrupt the delivery of adjuvant chemotherapy in patients with malignant tumors.

Postoperative complications of pancreaticoduodenectomy (PD) are still a thorny problem. This study aims to verify the preventative impact of T-tube on them.

The electronic medical records and follow-up data of patients who received pancreaticoduodenectomy in our center from July 2016 to June 2020 were reviewed. According to whether T tube was placed during the operation, the patients were divided into T-tube group and not-T-tube group. Propensity score matching analysis was performed to minimize selection bias.

A total of 330 patients underwent PD (Not-T-tube group =226, T-tube group=104). Propensity score matching resulted in 222 patients for further analysis (Not-T-tube group =134, T-tube group=88). Patients' demographics were comparable in the matched cohorts. Significantly higher incidences of clinically relevant postoperative pancreatic fistula (CR-POPF) ((14 (10.45%) VS 20 (22.73%)), P=0.013) were observed in the T-tube group. The total incidence of biliary anastomotic stricture (BAS) was 3.15%. The incidence was slightly lower in the T-tube group, but there was no statistically significant differentiation (6 (4.48%) VS 1 (1.14%), P=0.317).

It is not feasible to prevent postoperative complications with the application of a T-tube in PD.

Gastrointestinal malignancies, most specifically duodenal malignancy, are uncommon in the population; however, they are tricky to manage because the lesions are diagnosed at a late stage and located in a complex area. This case report focuses on a patient who was diagnosed with a second (descending) part of the duodenum (D2) malignancy; the tumour was localised at the second part of the duodenum, and the management of this patient was through the Whipple procedure or pancreaticoduodenectomy. The patient complained of stinging abdomen pain. Diagnostic examination comprised of CT and biopsy proved the presence of a malignant tumour originating from the D2 area. The tumour's characteristics and the patient's general health status are determined by using Whipple's procedure. Post-operative management entails the use of IV antibiotics, analgesics, multivitamins and nasojejunal (NJ) tube feeding. The case also expounds on the consequences of a multimodal treatment strategy, meticulous planning of the surgical procedure, and adequate post-operative management of D2 malignancies. These data may shed some light on the peculiarities of duodenal cancer management with the Whipple procedure; nonetheless, early diagnosis and proper management should remain the primary goals.

Biliary intraepithelial neoplasm (BilIN) and intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) are recognized as the two main precursors to biliary carcinoma. Surgical resection is the mainstay of treatment, with pancreaticoduodenectomy for extrahepatic biliary duct disease involving the pancreatic or distal portion of the bile duct, and bile duct and liver resection for perihilar and intrahepatic bile duct involvement. For diffuse IPMN-B with involvement of the entirety of the biliary epithelium of both intrahepatic and extrahepatic biliary systems, there is no well-documented consensus on treatment due to its rarity. Therefore, we present a case of a 56-year-old male with diffuse IPMN-B managed with combined orthotopic liver transplant and pancreaticoduodenectomy. As such, the clinical presentation, diagnostics, and unique course of intervention for our patient are described. This case provides insight into the topic of managing IPMN-Bs, particularly with diffuse biliary tree involvement. With such a rare disease with wildly varied presentations, consensus on a set treatment algorithm is nearly impossible to establish. This case describes one treatment pathway we found to be successful.

Pancreatoduodenectomy is the only cure for cancers of the pancreas and the periampullary region but has considerable operative complications and uncertain prognosis. Our goal was to analyse temporal improvements and provide contemporary population-based benchmarks for outcomes following pancreatoduodenectomy.

We empanelled a cohort comprising all patients in Sweden with pancreatic or periampullary cancer treated with pancreatoduodenectomy from 1964 to 2016 and achieved complete follow-up through 2016. We analysed postoperative deaths and disease-specific net survival.

We analysed 5923 patients with cancer of the pancreas (3876), duodenum (444), bile duct (504), or duodenal papilla (963) who underwent classic (3332) or modified (1652) Whipple's procedure or total pancreatectomy (803). Postoperative deaths declined from 17.2% in the 1960s to 1.6% in the contemporary time period (2010-2016). For all four cancer types, median, 1-year and 5-year survival improved substantially over time. Among patients operated between 2010 and 2016, 5-year survival was 29.0% (95% confidence interval (CI): 25.5, 33.0) for pancreatic cancer, 71.2% (95% CI: 62.9, 80.5) for duodenal cancer, 30.8% (95% CI: 23.0, 41.3) for bile duct cancer, and 62.7% (95% CI: 55.5, 70.8) for duodenal papilla cancer.

There is a continuous and substantial improvement in the benefit-harm ratio after pancreatoduodenectomy for cancer.

The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.

We retrospectively analyzed pancreatectomy patients and examined the occurrence rate and timing of postoperative complications (time-to-complication; TTC) and their impact on the length of postoperative hospital stay (POHS) to clarify their characteristics, provide appropriate postoperative management, and improve short-term outcomes in the future.

A total of 227 patients, composed of 118 pancreaticoduodenectomy (PD) and 109 distal pancreatectomy (DP) cases, were analyzed. We examined the frequency of occurrence, TTC, and POHS of each type of postoperative complication, and these were analyzed for each surgical procedure. Complications of the Clavien-Dindo (CD) classification Grade II or higher were considered clinically significant.

Clinically significant complications were observed in 70.3% and 36.7% of the patients with PD and DP, respectively. Complications occurred at a median of 10 days in patients with PD and 6 days in patients with DP. Postoperative pancreatic fistula (POPF) occurred approximately 7 days postoperatively in both groups. For the POHS, in cases without significant postoperative complications (CD ≤ I), it was approximately 22 days for PD and 11 days for DP. In contrast, when any complications occurred, POHS increased to 30 days for PD and 19 days for DP (each with additional 8 days), respectively. In particular, POPF prolonged the hospital stay by approximately 11 days for both procedures.

Each postoperative complication after pancreatectomy has its own characteristics in terms of the frequency of occurrence, TTC, and impact on POHS. A correct understanding of these factors will enable timely therapeutic intervention and improve short-term outcomes after pancreatectomy.

Background: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is associated with major postoperative morbidity and mortality. Several scoring systems have been described to stratify patients into risk groups according to the risk of POPF. The aim of this study was to compare scoring systems in patients who underwent a PD. Methods: A total of 196 patients undergoing PD from July 2019 to June 2022 were identified from a prospectively maintained database of the University Hospital Ghent. After performing a literature search, four validated, solely preoperative risk scores and the intraoperative Fistula Risk Score (FRS) were included in our analysis. Furthermore, we eliminated the variable blood loss (BL) from the FRS and created an additional score. Univariate and multivariate analyses were performed for all risk factors, followed by a ROC analysis for the six scoring systems. Results: All scores showed strong prognostic stratification for developing POPF (p < 0.001). FRS showed the best predictive accuracy in general (AUC 0.862). FRS without BL presented the best prognostic value of the scores that included solely preoperative variables (AUC 0.783). Soft pancreatic texture, male gender, and diameter of the Wirsung duct were independent prognostic factors on multivariate analysis. Conclusions: Although all predictive scoring systems stratify patients accurately by risk of POPF, preoperative risk stratification could improve clinical decision-making and implement preventive strategies for high-risk patients. Therefore, the preoperative use of the FRS without BL is a potential alternative.

Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed in advanced stages, necessitating pancreaticoduodenectomy (PD) as a primary therapeutic approach. However, PD surgery can engender intricate complications. Thus, understanding the factors influencing postoperative complications documented in electronic medical records and their impact on survival rates is crucial for improving overall patient outcomes.

A total of 749 patients were divided into two groups: 598 (79.84%) chose the RPD (Robotic pancreaticoduodenectomy) procedure and 151 (20.16%) chose the LPD (Laparoscopic pancreaticoduodenectomy) procedure. We used correlation analysis, survival analysis, and decision tree models to find the similarities and differences about postoperative complications and prognostic survival.

Pancreatic cancer, known for its aggressiveness, often requires pancreaticoduodenectomy as an effective treatment. In predictive models, both BMI and surgery duration weigh heavily. Lower BMI correlates with longer survival, while patients with heart disease and diabetes have lower survival rates. Complications like delayed gastric emptying, pancreatic fistula, and infection are closely linked post-surgery, prompting conjectures about their causal mechanisms. Interestingly, we found no significant correlation between nasogastric tube removal timing and delayed gastric emptying, suggesting its prompt removal post-decompression.

This study aimed to explore predictive factors for postoperative complications and survival in PD patients. Effective predictive models enable early identification of high-risk individuals, allowing timely interventions. Higher BMI, heart disease, or diabetes significantly reduce survival rates in pancreatic cancer patients post-PD. Additionally, there's no significant correlation between DGE incidence and postoperative extubation time, necessitating further investigation into its interaction with pancreatic fistula and infection.