Diarrhea after pancreatic surgery is gaining growing importance since extended pancreatic resections have been increasingly performed. The aim of this study was to determine the incidence of diarrhea after pancreatic surgery with a special focus on the extent of resection and subgroups at higher risk for diarrhea. Retrospectively collected data of all consecutive patients undergoing pancreatic surgery between 01/2021 and 11/2023 were analyzed. Information on bowel movements was prospectively documented. Diarrhea was defined as > 3 bowel movements per day for at least 72h despite pancreatic enzyme replacement and in the absence of laxatives or prokinetics. Extended resections were differentiated according to the type of vascular resection and arterial divestment. Clinicopathological characteristics and outcomes were compared among these groups and risk factors for diarrhea were identified. A total of 320 patients were included. Following any type of pancreatectomy, 71/320 (22.2%) patients developed diarrhea. The incidence of diarrhea after partial pancreatoduodenectomy, distal pancreatectomy and total pancreatectomy was 26.6%, 11.5% and 35.3%, respectively (p = 0.004). Arterial divestment/resection and venous resection were significantly associated with an increased risk for postoperative diarrhea in 87% (OR = 31.14; 95%-CI: 8.77, 170.08; p < 0.001) and 52.2% of patients (OR = 5.14; 95%-CI: 2.51, 10.52; p < 0.001), respectively. Postoperative diarrhea was significantly associated with a prolonged length of hospital stay (19 vs. 13 days; 95%-CI: 3.00, 7.00; p < 0.001). Diarrhea after pancreatic resection is a common postoperative complication affecting especially patients undergoing extended resections with vascular resections and arterial divestment. Diarrhea significantly impairs postoperative recovery leading to a prolonged hospital stay.

Postoperative pancreatic fistula (POPF), particularly clinically relevant grades B and C (CR-POPF), remains a major source of morbidity following pancreatoduodenectomy (PD). Robotic pancreatoduodenectomy (RPD) has emerged as a minimally invasive alternative to open PD (OPD), potentially offering technical advantages that reduce complication rates. However, the true impact of RPD on CR-POPF remains unclear. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, including studies published between January 2010 and June 2025. PubMed, Embase, Scopus, and Web of Science were queried for randomized trials, cohort studies, and propensity score-matched (PSM) analyses comparing RPD and OPD concerning CR-POPF as defined by the International Study Group on Pancreatic Surgery (ISGPS). Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was graded using the GRADE framework. Thirty-two studies encompassing over 24 000 patients were included, of which approximately 5 000 underwent RPD and 19 600 underwent OPD. The pooled analysis showed a significantly lower incidence of CR-POPF in the RPD group (OR 0.60, 95% CI 0.51-0.67; p < 0.001), with moderate heterogeneity (I2 = 56%). Subgroup analysis indicated that the benefit was limited to high-volume centers (≥ 20 RPD annually) and matched studies, while the two available randomized trials did not show a significant difference. RPD is associated with a reduced incidence of CR-POPF when performed in experienced, high-volume centers. These findings support the selective implementation of RPD within structured training and quality-control programs. Further high-quality randomized trials are needed to validate these results and explore long-term outcomes.

Perioperative multidrug-resistant bacteria impair clinical outcome after pancreatic surgery: Missed targets of antibiotic prophylaxis.

Race and ethnicity data missingness in hepatobiliary and pancreatic surgery: prevalence and outcomes.

Impact of body mass index on postoperative mortality after pancreatic resection: A systematic review and meta-analysis.

Obesity is a known risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). However, the body mass index (BMI) does not adequately reflect fat distribution or distinguish between fat and muscle mass. The waist-to-height ratio (WHR), an indicator of central adiposity, may provide complementary value to BMI in assessing the risk of POPF. This study retrospectively analyzed 523 patients who underwent PD, excluding those with pancreatic cancer. Preoperative computed tomography (CT) was used to evaluate BMI, WHR, and visceral/subcutaneous fat area. The study defined POPF as International Study Group on Pancreatic Surgery (ISGPS) grade B or C. The distributions of BMI and WHR were examined, and the predictive performance of POPF was evaluated. The overall incidence of POPF was 52.2%. Although only 16.8% of the patients met the BMI-based definition of obesity (BMI ≥ 25 kg/m2), 57.4% exhibited central adiposity (WHR ≥ 0.5). Of the entire cohort, 40.7% had a "normal" BMI but an elevated WHR. The optimal cutoff values determined by Youden's index were 21.96kg/m2 for BMI and 0.51 for WHR, both of which demonstrated good predictive accuracy (area under the receiver operating characteristic (ROC) curve, 0.797 and 0.779, respectively). A multivariate analysis showed that both BMI-defined obesity (odds ratio [OR], 6.96; p < 0.001) and WHR-defined central adiposity (OR 6.75; p < 0.001) were independently associated with POPF. The WHR is a simple and useful marker that complements BMI in preoperative assessment of the risk of POPF. It can identify patients with central adiposity who may not be classified as obese by BMI alone, thus enhancing preoperative risk stratification.

ASO Author Reflections: Neoadjuvant Treatment and Clinically Relevant Chyle Leak in Pancreatic Surgery: Recognizing a New Risk Factor.

Chinese Journal of Surgery dates back to 1951, a time when pancreatic surgery was emerging in China. Due to the deep anatomical location and complex physiological functions of the pancreas, pancreatic diseases are often severe and challenging to treat. Since its inception, Chinese Journal of Surgery has comprehensively documented the evolution of pancreatic surgery in China from its nascent stages to robust maturation, while actively propelling the advancement of this discipline domestically. This article reviews the 75-year journey of Chinese pancreatic surgeons who, through relentless dedication and exploration, have progressed from following international peers to standing shoulder-to-shoulder and even leading in the management of pancreatic diseases, including pancreatic cancer, severe acute pancreatitis, pancreatic neuroendocrine tumors, and chronic pancreatitis. It aims to inspire colleagues to seize opportunities, pursue innovation, and sustain the vitality and growth of pancreatic surgery in China.

This study compares robotic-assisted pancreatic surgery (R-PS) and laparoscopic pancreatic surgery (L-PS) outcomes in patients with pancreatic malignancies and medium- to high-risk pancreatic fistulas. A retrospective cohort study was conducted at Guangdong Provincial People's Hospital (2021-2023). The primary endpoints were major complications (Clavien-Dindo grade≥III) and postoperative morbidity. 200 R-PS and 400 L-PS patients were included, with 163 pairs matched. R-PS showed lower conversion rates (2.5% vs. 17.2%, p<0.001), less blood loss (119 vs. 179mL, p=0.013), and faster function recovery (8.2 vs. 9.6days, p=0.038). Postoperatively, R-PS had fewer pancreatic fistulas in malignant (4.1% vs. 32.6%, p<0.001) and moderate to high-risk cases (8.3% vs. 16.7%, p=0.026). R-PS benefits are not procedure-specific. R-PS offers advantages in blood loss, complications, and fistula prevention, suggesting it may be preferable for complex pancreatic surgeries.

Introduction: Pancreatico-duodenectomy (PD) remains one of the most complex abdominal surgeries, and pancreatico-jejunostomy (PJ) fistula is its most critical postoperative complication. In efforts to reduce the incidence of postoperative pancreatic fistula (POPF), several PJ techniques and adjuncts, including stents, have been recommended. This article presents data from an international survey regarding PJ methods, the use of pancreatic stents, and their correlation with POPF rates from surgical centers worldwide. Methods: A nine-item online questionnaire was sent globally through social networks, individual mailing lists, and the ASHBPS mailing list. Data were analyzed through the Student’s t-test (two-tailed, unequal variance). A p-value &lt; 0.05 was considered to be statistically significant. Results: A total of 122 units of pancreatic surgery from 26 countries distributed across five continents responded to the survey. Most centers performed less than 50 PDs a year, preferred a duct-to-mucosa PJ, and employed a stent routinely. Mean POPF grade B and C incidences were lower in high-volume (15.24% ± 7.29 and 3.95% ± 2.39) and in PJ stent-using centers (16.25% ± 8.7 and 5.37% ± 7.49). Conclusions: Institutional case volume and stent usage are more crucial determinants of POPF incidence than the PJ technique itself. Centralization and standardization of PD procedures are related to reductions in major fistula rates.

Multidisciplinary advances in pancreatic cancer surgery: a scientific report from the 2024 Salerno conference

Background: Obstructive jaundice is a common problem in surgical and gastro-enterological practice. Cause of obstruction is heterogeneous that includes both benign and malignant conditions. Management also varied according to pathology and level of obstruction. Objective: To identify the causes of obstructive jaundice and management techniques employed in those cases in Dhaka combined military hospital. Methods: This prospective observational study was carried out in the department of hepatobiliary and pancreatic surgery of Dhaka combined military hospital. Sample size of the study was 96. Entry of the various variables of the each clinical data were done and were analyzed by computer based program SPSS (Statistical Package for Social Science, version 25.0). Means of the continuous variables of the groups were compered by Independent sample t test and nominal variables were compered by Chi square test. Results: Mean age of the study population was 55.11 years. Mean age of malignant cases was about 10 years more than benign cases (60.19 years vs 51 years). Choledocholithiasis was the most common (42.7%) benign cause of obstructive jaundice, whereas periampullary carcinoma (12.5%), carcinoma head of pancreas (10.4%) and cholangiocarcinoma (10.4%) were three most common causes of malignant obstruction. Choledocholithiasis was managed mostly by ERCP (48.78%) and open surgery (39.02%). 100% cases of periampullary carcinoma were managed by curative surgery, whereas only 40% cases of carcinoma head of pancreas and 20% cases of cholangiocarcinoma were managed by curative surgery. Conclusion: Choledocholithiasis was the most common benign etiology that particularly inflicts in younger age group. Malignant etiology was causing obstruction in older age group. ERCP is the first line of management in choledocholithiasis.Curative surgery was almost always possible in case of periampullary carcinoma. Bangladesh Armed Forces Med J Vol 58 No (1) June 2025, pp 39-47

Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile. To define reference values for TP based on a low-risk cohort treated at expert centers. This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities. TP. Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy. Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29). This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.

Persistence of Healthcare Disparities in Pancreatic Operation for Cancer in the US.

Solitary pulmonary nodules in postoperative pancreatic cancer patients pose a diagnostic challenge in distinguishing primary lung cancer (PLC) from pulmonary metastasis (PM). KRAS mutation analysis is a potential tool for distinguishing these entities. A retrospective study of 17 patients who underwent pulmonary resection after pancreatic cancer surgery was conducted. Paired pancreatic and pulmonary tumor samples were analyzed for KRAS mutations. PDX1 expression was assessed by immunohistochemistry. Preoperative clinical factors were evaluated using KRAS mutation-based classification as the reference. KRAS mutations were discordant between pancreatic and pulmonary tumors in nine patients (53%), leading to a diagnosis of PLC. KRAS G12R concordance was observed in three cases, confirming PM. Five cases with KRAS G12D or G12V concordance could not be definitively classified. KRAS mutation analysis identified more PLC cases than pathological diagnosis. PDX1 expression was found in both PM and some PLC cases, as well as in lung invasive mucinous adenocarcinoma cases without pancreatic cancer history, limiting its diagnostic value. Lymphovascular invasion in the pancreatic tumor was significantly associated with PM. KRAS mutation analysis of both pancreatic tumor and lung tumor is useful for distinguishing solitary pulmonary nodules in postoperative pancreatic cancer patients. KRAS mutation analysis identified PLC more frequently than conventional pathological diagnosis.

Comprehensive preoperative risk stratification is essential for improving perioperative outcomes and guiding informed decisions in general surgery (GS). However, data scarcity remains a key challenge to developing robust, high-dimensional artificial intelligence (AI) models. To address this data barrier in surgical AI, transfer learning (TL) enables neural networks (NNs) to transfer and adapt knowledge from pre-trained source models to new domains with critically limited data availability. This multicenter study included patients undergoing advanced GS at three tertiary centers between 2015 and 2023. Multiple large-scale source models for 90-day mortality prediction were trained on 85 preoperative parameters. Subsequently, organ-specific fine-tuning was performed for esophageal, liver, pancreatic, and colorectal surgery individually. TL models were benchmarked against standard ML models and conventional risk scores using the area under the receiver-operating characteristic curve (AUROC), precision-recall curve (AUPRC), and F1-score including 95% confidence intervals. Feature analyses were performed for each NN to investigate and compare model interpretability. 14,922 patients (mean [SD] age: 58.5 [16.1] years) were included. Conventional ML achieved AUROCs of 0.75 (0.72-0.79; esophageal surgery), 0.80 (0.79-0.82; liver surgery), 0.73 (0.71-0.76; pancreatic surgery) and 0.92 (0.92-0.92; colorectal surgery) with corresponding AUPRCs reaching 0.37 (0.33-0.43), 0.30 (0.29-0.31), 0.29 (0.24-0.34), and 0.57 (0.56-0.58), respectively. TL significantly improved AUPRCs by 38% in esophageal (0.54 [0.51-0.58], p<0.001), 14% in liver (0.34 [0.32-0.36], p<0.001), and 8% in pancreatic surgery (0.31 [0.28-0.37], p<0.001). Patient age and the Charlson Comorbidity Index (CCI) consistently emerged as the highest-weight features across all TL models. All NNs outperformed the ASA physical status and CCI as conventional risk scores in predicting mortality. Machine learning outperforms conventional risk modeling in preoperative mortality prediction. Transfer learning can significantly enhance model performance in surgical domains with limited data availability, offering a promising approach to overcome persisting data constraints for AI in surgery.

BackgroundPostpancreatectomy hemorrhage (PPH) is a severe complication in pancreatic surgery. This study focused on early PPH (E-PPH), aiming to identify its characteristics, evaluate the existing grading criteria by the International Study Group of Pancreatic Surgery (ISGPS), and explore effective treatment strategies.MethodsPatients undergoing pancreatic surgery between March 2020 and January 2024 in two institutions were screened from prospectively maintained databases. Patients with E-PPH were divided into intervention group and the conservative group. The sites of hemorrhage were determined and categorized. Clinical presentation and outcomes were compared among different grades and interventions.ResultsAmong 4062 patients who underwent pancreatic surgery, 113 cases of E-PPH were identified, with an incidence of 2.8%. E-PPH was more concentrated within 24 h (76.2%) and occurred more extraluminally (78.2%). The intervention group had a higher proportion of hemodynamic instability (40.9%) and ICU stays (54.5%). E-PPH in the mesenteric region was more common in pancreaticoduodenectomy (81.9%) and open surgery (90.9%). Branches of the common hepatic artery and superior mesenteric vessel were the majority responsible vessels. Appropriate E-PPH treatment was effective, with successful hemostasis in all intervention cases. The occurrence of ICU admission, the length of ICU and postoperative hospital stay and 90-day mortality were not significantly different between different grades with intervention.ConclusionAppropriate therapy for E-PPH could lead to a favorable prognosis. The current definitions and grades for PPH are inadequate and require further modification.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00423-025-03896-1.

BackgroundThe aim of this study was to evaluate the clinical utility of the monocyte distribution width (MDW) as an early diagnostic biomarker for detecting postoperative complications in pancreatic surgery patients. Complications from pancreatic surgery, particularly pancreatic fistulas, significantly reduce patient survival rates. Compared with conventional markers, changes in the MDW may be detected earlier, facilitating timely intervention and potentially improving patient outcomes.MethodsThe MDW, C-reactive protein (CRP) level, and white blood cell (WBC) count were measured preoperatively and on postoperative days 1, 3, and 7. Complications—including clinically relevant pancreatic fistulas (CR-POPF) and anastomotic leaks—were classified using standardized criteria. Statistical analysis involved ROC curves and multivariate modelling to assess diagnostic accuracy and independent predictors. This retrospective analysis of a prospectively collected cohort included 82 patients who underwent elective pancreaticoduodenectomy (PD) for cancer at a single centre between May 2021 and March 2024.ResultsIn this cohort of 82 patients with prospective data collection and retrospective analysis who underwent PD, the MDW emerged as a significant early predictor of postoperative complications. On postoperative day 3, the MDW was independently associated with CR-POPF (AUC 0.781; OR 1.31, p = 0.044) and anastomotic leaks (ΔMDW days 0–3: OR 1.30, p = 0.015).Compared with conventional markers, the MDW demonstrated superior diagnostic performance, with ROC AUC values ranging from 0.770 to 0.818 across different complications. A day 3 cut-off value of > 23.1 showed high sensitivity (84%) and yielded positive likelihood ratios of up to 3.7. Furthermore, the MDW on day 3 was moderately to strongly correlated with subsequent inflammatory markers, such as the CRP level, on day 7 (r = 0.468, p < 0.001). Multivariate models confirmed the independent prognostic value of the MDW for predicting overall complications, anastomotic leaks, and CR-POPF.ConclusionCompared with the CRP level and WBC count, the MDW demonstrated superior and earlier predictive ability for detecting postoperative complications. Its elevation by day 3 provided early warning, especially for CR-POPF and leaks. As a rapid, cost-effective marker available from routine blood counts, the MDW may enhance postoperative monitoring and guide timely intervention.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03272-2.

The impact of institutional volume of minimally invasive pancreatic resection on short- and long-term outcomes for pancreatic ductal adenocarcinoma: differences between laparoscopic and robotic approaches.

Anti-inflammatory and anti-nociceptive effects of individualized blood pressure strategy based on low-dose noradrenaline infusion in elderly patients following major surgery: A randomized, controlled study.