Identification of robust associations between admission microbiome profiles and complications of acute pancreatitis.

Objective: Patients with acute pancreatitis show reduced gut microbiome diversity and high abundance of pathogenic bacteria compared with healthy subjects. Admission microbiome profiles are increasingly linked to severity, but methodology and study quality hamper interpretation. Our aim was to investigate whether admission microbiome analysis provides robust and reproducible associations with severity and complications of acute pancreatitis.

Time-varying impact of established prognostic factors in resected pancreatic ductal adenocarcinoma.

Background: Prognostic factors in resected pancreatic ductal adenocarcinoma (PDAC) have been determined under the assumption that hazard ratios (HRs) remain static. However, PDAC is a dynamic disease with evolving conditional survival. The aim of this study was to determine if the impact of prognostic factors in PDAC is time-varying.

Development and provider assessment of a new oncology network with care pathways for gastrointestinal cancer patients: the collaborative approach.

Background: In an era of increasing demands on healthcare services, the development of regional oncology networks including care pathways may be instrumental to improve the efficiency and quality of care. However, developing such networks involving numerous stakeholders and hospitals is challenging as no templates exist. This study evaluates the development of a large regional network with the objective to provide a practical template.

Surgical Complications in Patients with (borderline) Resectable Pancreatic Cancer after Neoadjuvant Therapy in the PREOPANC-2 Randomized Controlled Trial.

Objective: To compare the incidence of major surgical complications between patients with (borderline) resectable pancreatic cancer treated with neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy.

Summary Of Background Data: There are ongoing concerns regarding the possible adverse impact of neoadjuvant treatment on postoperative complication rates following pancreatectomy.

Methods: This study was a predefined analysis within the investigator-initiated nationwide randomized controlled PREOPANC-2 trial.

Predictors For Successful Treatment of Infected Necrotizing Pancreatitis With Antibiotics Alone: A Nationwide Prospective Cohort.

Objective: To identify predictors for successful treatment of patients with infected necrotizing pancreatitis with antibiotics alone.

Background: Infected necrotizing pancreatitis is associated with mortality ranging from 15-35%. Recent studies have shown that in some patients, treatment with antibiotics alone is successful, thus avoiding invasive procedures.

The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN).

Importance: The lack of multidisciplinary workflow guidelines and clear definitions and classifications for neoplasms in and around the ampulla of Vater results in inconsistencies affecting patient care and research.

Objective: The PERIPAN international multidisciplinary consensus group aimed to standardize the multidisciplinary diagnostic workflow and achieve consensus on definitions and classifications in order to ensure proper classification and optimal diagnostic assessment and consequently to improve patient care and future research.

Design: An international team of 43 experts (pathologists, surgeons, radiologists, gastroenterologists, oncologists) from 12 countries identified knowledge gaps, reviewed 37061 articles, and proposed recommendations using the Scottish Intercollegiate Guidelines Network methodology (SIGN), including the Delphi methodology and the AGREEII tool for quality assessment and external validation.

Incidence and Outcomes of Intraductal Oncocytic Papillary Neoplasm-Derived Pancreatic Cancer Compared with Tubular and Colloid Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: An International Multicenter Retrospective Study.

Background: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer was previously categorized into tubular, colloid, and oncocytic subtypes. Intraductal oncocytic papillary neoplasms (IOPN) has long been associated with superior prognosis/indolent behavior, however, there is discordant emerging evidence. This study aimed to investigate this conflicting literature.

Minimally invasive first stage with same-admission right portal vein embolization preparing for two-stage hepatectomy: safety and efficacy.

Background: Two-stage hepatectomy (TSH) expands local treatment options in patients with extensive bilobar liver tumors. The success of TSH depends on rapid recovery after first-stage treatment, effective hypertrophy induction, and precise functional liver remnant function assessment to minimize the risk of posthepatectomy liver failure (PHLF). This study aimed to assess the safety and efficacy of minimally invasive left-sided local liver treatment with or without partial associated liver partition and portal vein ligation for staged hepatectomy (pALPPS) or pALPPS alone combined with same-admission right portal vein embolization (PVE) and routine assessment of liver function using hepatobiliary scintigraphy (HEBIS).

Molecular Classification of Resected Primary Duodenal Adenocarcinoma.

Introduction: The molecular and histological characteristics of primary duodenal adenocarcinoma (DA) have been poorly described, which hampers the development of new treatment options. This study aimed to characterize the landscape of chromosomal copy number aberrations (CNAs), microsatellite instability status, and tumor-stroma content, and their association with clinicopathological characteristics of patients with DA.

Methods: DNA was extracted from tumor tissues of patients who underwent a primary surgical resection for DA in a single center (2000-2019).

Managing a Replaced Right Hepatic Artery During Robot-Assisted Pancreatoduodenectomy in Practical Steps.

Background: A replaced right hepatic artery (rRHA) arising from the superior mesenteric artery (SMA) is the most common hepatic arterial variant, occurring in ~12% of the population. Its close anatomical relationship with the pancreatic head poses significant challenges in hepatobiliary and pancreatic surgery, making it particularly vulnerable to injury during dissection. This can lead to ischemic complications or necessitate complex vascular reconstruction.

Robot-assisted and Laparoscopic Extended Left Pancreatectomy: A Pan-European Multicenter Propensity-score Matched Analysis.

Objective: To compare postoperative outcomes after extended robot-assisted left pancreatectomy (e-RLP) and extended laparoscopic left pancreatectomy (e-LLP).

Summary Background Data: The implementation of RLP is increasing worldwide with expanding indications, resulting in more extended resections. However, the use of e-RLP has not been investigated before.

Online video versus face-to-face preoperative consultation for major abdominal surgery (VIDEOGO): a multicentre, open-label, randomised, controlled, non-inferiority trial.

Background: Online video consultation between patients and health-care providers rapidly gained popularity during the COVID-19 pandemic. However, to our knowledge, there is no high-quality comparative evidence regarding patient satisfaction and quality of information recall with online video consultation and traditional face-to-face consultation. This lack of evidence is especially concerning in the most demanding consultations.

Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: nationwide study.

Background: Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay.

Health-related quality of life in patients undergoing laparoscopic versus open hemihepatectomy: a secondary analysis of the ORANGE II PLUS randomised controlled, phase 3, superiority trial.

Background: Health-related quality of life (HRQoL) has become a critical factor in determining the benefits of new surgical approaches on patients. The ORANGE II PLUS randomised trial compared laparoscopic (LH) and open (OH) hemihepatectomy in an international multicentre randomised controlled setting, with HRQoL as a secondary outcome. The aim of this study was to perform an in-depth analysis of the HRQoL outcomes.

Robotic versus laparoscopic liver resection: a systematic review and meta-analysis of comparative studies.

Background: The technical advantages of robotic platforms may facilitate minimally invasive liver resections, improving outcomes over the laparoscopic approach. This meta-analysis aimed to compare outcomes of robotic liver resection (RLR) versus laparoscopic liver resection (LLR).

Materials And Methods: A systematic literature search identified matched cohort studies and randomized controlled trials comparing RLR and LLR from 2003 to 2024.

Routine Imaging After Resection of Pancreatic Ductal Adenocarcinoma: Nationwide Utilization and Survival Analysis.

Objective: To evaluate the utilization of routine imaging and the impact on survival after resection of pancreatic ductal adenocarcinoma (PDAC).

Background: Evidence on the benefit of routine imaging after resection of PDAC on early detection and treatment of disease recurrence is currently lacking. The availability of more effective treatment options for PDAC recurrence may have increased the utilization of routine imaging in daily clinical practice.

Adjuvant therapy after resection of intraductal papillary mucinous neoplasm-derived pancreatic cancer: A systematic review and meta-analysis.

Introduction: The management of intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer is extrapolated from pancreatic intraepithelial neoplasm (PanIN)-derived pancreatic cancer. However, these cancers are biologically and clinically distinct and evidence regarding the role of adjuvant therapy (AT) is unclear. The aim of this systematic review and meta-analysis was to consolidate current evidence regarding survival benefit of AT for IPMN-derived pancreatic cancer.

Assessing the Potential Difficulty of Left Pancreatectomy: International Modified Delphi Consensus.

Introduction: Left pancreatectomy (LP) is the consensus term for the surgical procedure previously known as distal pancreatectomy. Several approaches and techniques are included in the LP definition, with varying difficulty. Several factors may contribute to the difficulty of LP.

Predicting postoperative pancreatic fistula after robotic pancreatoduodenectomy using International Study Group on Pancreatic Surgery and fistula risk scores: European multicentre retrospective cohort study.

Background: Postoperative pancreatic fistula represents the leading cause of morbidity and mortality after robotic pancreatoduodenectomy. Various scores have been proposed to stratify patients based on their postoperative pancreatic fistula risk, including three fistula risk scores, and two International Study Group for Pancreatic Surgery scores. This study compares the performance of these scores in patients undergoing robotic pancreatoduodenectomy.

Survival after neoadjuvant and induction FOLFIRINOX versus gemcitabine-nab-paclitaxel in patients with resected localised pancreatic adenocarcinoma: an international multicentre study.

Background: It remains unclear whether there is a difference in overall survival (OS) benefit between (m)FOLFIRINOX and gemcitabine-nab-paclitaxel as preoperative regimens for localised pancreatic adenocarcinoma. This study aimed to investigate the outcome of patients with resected localised pancreatic adenocarcinoma following (m)FOLFIRINOX versus gemcitabine-nab-paclitaxel.

Methods: International multicentre retrospective study (16 centres, 8 countries, 3 continents), including consecutive patients after pancreatic resection for localised pancreatic adenocarcinoma following 2-6 months preoperative (m)FOLFIRINOX or gemcitabine-nab-paclitaxel (2010-2018).