It has previously been demonstrated that Thrombelastography(TEG) angle may be associated with recurrence and survival in pancreas cancer in a cohort of patients operated on at the University of Colorado in 2016–2017. Now approaching 10 years of follow-up, we revisit these associations and strengthen these claims with multivariate analysis.

The majority of previously published meta-analyses compare robotic and laparoscopic pancreaticoduodenectomy (RPD vs. LPD) across both benign and malignant lesions. This meta-analysis aims on focusing exclusively on malignant lesions, providing a detailed and targeted evaluation of operative, oncologic, and post-operative outcomes. This systematic review and meta-analysis adhered to PRISMA 2020 guidelines and the Cochrane Handbook and followed a pre-registered protocol on PROSPERO. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was conducted up to August 1, 2024. Risk of bias was performed with the ROBINS-I tool. We calculated the odds ratios and the mean differences for the dichotomous and continuous outcomes, respectively. Sensitivity analysis was conducted to evaluate the robustness of findings. Subgroup analyses were performed for pancreatic cancer cases exclusively. In total, eight studies involving 6648 patients (1964 RPD and 4684 LPD) were included. Significant outcomes included reduced length of hospitalization for RPD (MD = −0.94, P = 0.005) and lower conversion rates (OR = 0.20, P < 0.00001). In addition, the number of harvested lymph nodes was significantly higher for RPD (MD = 1.02, P = 0.01). Overall morbidity was significantly lower for RPD (OR = 0.50, P = 0.05). Non-significant differences were observed for estimated blood loss (P = 0.72), operative duration (P = 0.28), blood transfusion rates (P = 0.12), R0 resection rates (P = 0.60), major complications (P = 0.54), pancreatic fistula rates (P = 0.06), delayed gastric emptying (P = 0.58), reoperation rates (P = 0.20), and 90-day mortality (P = 0.97). Sensitivity analysis reduced heterogeneity without altering significant results, with the exception of overall morbidity which became non-significant in some cases, highlighting study-specific influences. Subgroup analysis for pancreatic cancer showed consistent findings with the main analysis, except overall morbidity, which became non-significant, suggesting that periampullary cancers may have influenced the observed benefits of RPD. Further analysis was limited by data availability. While RPD offers potential benefits, including shorter hospitalization, lower conversion rates, higher number of harvested lymph nodes and lower morbidity, the limited number of high-quality studies, study heterogeneity, and conflicting evidence with prior meta-analyses underscore the need for further well-designed trials focusing on specific patient populations to guide surgical decision-making. PROSPERO registration CRD42025634636.

Background Robotic pancreaticoduodenectomy (RPD) has emerged as a promising surgical approach for the treatment of periampullary neoplasms, offering the potential benefits of minimally invasive surgery. However, the impact of RPD on clinically relevant pancreatic fistula (CR-PF) rates and overall costs compared to open pancreaticoduodenectomy (OPD) remains unclear, limiting its widespread adoption. Methods This retrospective cohort study was conducted at a high-volume Japanese referral center from 2017 to 2023. A total of 193 patients diagnosed with periampullary neoplasms underwent either RPD (n = 81) or OPD (n = 112). To account for potential selection bias, propensity score matching (PSM) was used to balance patient demographics and clinical characteristics, resulting in two well-matched groups of 60 patients each. Perioperative outcomes, CR-PF rates, and a comprehensive cost analysis were evaluated. Results RPD resulted in a significantly lower rate of CR-PF (10%) compared to OPD (33.3%) (p = 0.003). Additionally, patients who underwent RPD experienced shorter hospital stays (15 days) compared to those in the OPD group (22.5 days) (p < 0.001). Despite longer operative times for RPD (633 vs. 395 min; p < 0.001), total hospital costs were comparable between the two groups. The higher operative costs associated with RPD were offset by reduced postoperative complications and shorter hospitalization. Conclusions RPD offers significant clinical advantages, including lower CR-PF rates and reduced hospital stays, without increasing overall hospital costs compared to OPD. These findings support the feasibility and potential benefits of adopting RPD for the management of periampullary neoplasms in clinical practice. Graphical abstract

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Most present-day survival-models of patients with cancer do not account for tumor-host interactions. We hypothesized that host phenotypes based on sys…

Most patients undergoing pancreatoduodenectomy after neoadjuvant therapy for periampullary malignancies have pancreatic adenocarcinoma, a known protec…

A newly optimized classification model better predicts postoperative pancreatic fistula risk in patients undergoing pancreatoduodenectomy for periampullary tumors.Overall, the rate of clinically relevant pancreatic fistula was 22.2%, rising to 25.8% specifically for periampullary tumors.The original model showed moderate predictive performance (AUC = 0.632), but the adjusted version improved this to 0.672.Understanding these risk factors helps

A consensus of 43 international experts has established the Brescia PERIPAN guidelines to address inconsistencies in diagnosing neoplasms near the ampulla of Vater. The comprehensive recommendations encompass enhanced anatomical definitions, refine tumor classifications, and improve pathology assessment protocols. By clarifying distinctions between ampullary and other periampullary tumors, this initiative aims to elevate patient care and

Radiological assessment following pancreaticoduodenectomy is critical for the prompt diagnosis and management of postoperative complications, significantly influencing patient outcomes. Pancreaticoduodenectomy, or the Whipple procedure, is the standard surgical intervention for pancreatic and periampullary malignancies, but it involves notable risks, especially from complications like fistulas, bleeding, or leakage. Cross-sectional imaging, particularly contrast-enhanced computed tomography, serves as the primary diagnostic tool due to its rapid acquisition, high resolution, and effective delineation of postoperative anatomy and complications. Magnetic resonance imaging (with cholangiopancreatography and hepatobiliary contrast agents) complements CT by providing superior contrast resolution for specific complications, notably in the biliary system and pancreatic duct. This narrative review discusses various imaging techniques and their applications, highlighting characteristic radiological features of common postoperative complications. It underscores the importance of a multidisciplinary approach, emphasizing close collaboration between radiologists and surgeons to optimize surgical decision-making and improve patient management post-pancreatic surgery.

BACKGROUND. A number of patients with periampullary carcinoma deemed resectable on preoperative CT have their curative-intent surgery aborted on the basis of intraoperative findings. OBJECTIVE. This study sought to identify imaging and clinical factors associated with aborted curative-intent Whipple procedures for periampullary adenocarcinoma. METHODS. Ten U.S., Canadian, and French institutions contributed data to this retrospective case-control study of 360 adults (220 men, 140 women; mean age, 68.6 ± 8.4 [SD] years) with periampullary adenocarcinoma who underwent curative-intent Whipple procedures between January 2016 and December 2022. A total of 180 patients for whom the procedure was aborted (case group) were matched by sex and 5-year age blocks with 180 patients for whom the procedure was completed (control group). Covariates included cancer type, tumor size and resectability on CT, CT reconstruction slice thickness including by phase, number of phases, multiplanar imaging, reconstruction at the workstation, possible metastases reported, structured versus unstructured report, reporting radiologist's experience, hepatic steatosis, preoperative liver MRI, endoscopic ultrasound, ERCP, multidisciplinary review, neoadjuvant therapy and response, and serum CA 19-9 and CEA levels. Logistic regression was performed with ORs and 95% CIs. RESULTS. Whipple procedures were most frequently aborted because of metastases (67.2% [121/180]), followed by locally unresectable disease (27.8% [50/180]). Serum CA 19-9 levels of 37 U/mL or more were associated with aborted Whipple procedures with an OR of 3.75 (95% CI, 1.22–12.77) that increased to 5.47 (95% CI, 1.80–18.62) when a cutoff of 200 U/mL was applied. CT slice thickness ranged from 0.5 mm to 5 mm. CT examinations that used only slice thicknesses of 2.5 mm or more were independently associated with aborted Whipple procedures (OR = 4.28 [95% CI, 1.37–15.00]), including when assessing only pancreatic ductal adenocarcinoma. No other variables showed statistically significant association. CONCLUSION. Elevated serum CA 19-9 levels and preoperative CT using only slice thicknesses of 2.5 mm or more were associated with aborted curative-intent Whipple procedures. Many other imaging and clinical factors did not show an association. CLINICAL IMPACT. If curative-intent surgery is planned in patients with periampullary carcinoma, preoperative CT should be performed using reconstructions smaller than 2.5 mm to reduce the likelihood of incorrect staging.