To honour Pancreatic Cancer Awareness Month, we are highlighting some of the most important research published this year in BJS Journals, BJS and BJS Open, on pancreatic cancer. Advancing research in this field is essential to improving patient outcomes and offering hope. Together, we can make a difference.
_____
BJS highlights:
______
Nationwide outcomes of 1000 robotic pancreatoduodenectomies across the four phases of the learning curve
Nationwide retrospective cohort study including 1000 consecutive RPDs (2016–2023) across 13 Dutch centers.
The study assessed how outcomes evolve beyond the initial learning curve of RPD implementation.
Operating time, conversion rate, delayed gastric emptying (grade B/C), reoperation rate, and hospital stay significantly improved across the four learning phases.
Major complications (Clavien–Dindo ≥III) and 30-day/in-hospital mortality remained constant, indicating maintained safety throughout learning progression.
After overcoming the early learning phase, RPD outcomes showed clear efficiency gains without compromising morbidity or mortality.
______
Impact of pre-compression versus non-compression before parenchyma transection in left-sided pancreatic resection on the rate of clinically relevant pancreatic fistula: multicentre randomized clinical trial
Multicentre randomized controlled trial conducted in 13 hospitals in Japan (2021–2023), enrolling 171 patients undergoing left-sided pancreatic resection.
Patients were randomly assigned to pre-compression or non-compression groups to assess whether parenchymal pre-compression reduces grade B/C postoperative pancreatic fistula.
The incidence of grade B/C pancreatic fistula was 12.5% in the pre-compression group and 13.3% in the non-compression group, with no statistically significant difference (OR 0.94, P = 0.883).
The trial found that parenchymal pre-compression did not reduce the risk of clinically relevant pancreatic fistula after left-sided pancreatic resection.
______
Surgery for chronic pancreatitis across Europe (ESCOPA): prospective multicentre study
Prospective multicentre cohort including 207 patients from 22 centers in 13 European countries (2021–2022).
The study evaluated indications, surgical techniques, and outcomes of surgery for symptomatic chronic pancreatitis.
Major morbidity occurred in 14.0% and 90-day mortality in 1.4%. Among 113 patients operated on for pain, the median Izbicki score decreased from 61.3 to 19.0 at 6 months, with pain relief achieved in 72.6% and significant improvement in quality-of-life scores.
Longer symptom duration and preoperative opioid use were associated with lower rates of pain relief.
Surgery provided substantial pain and quality-of-life improvement with low morbidity and mortality, supporting early multidisciplinary evaluation for patients with chronic pancreatitis.
______
International multicentre validation of the left pancreatectomy pancreatic fistula prediction models and development and validation of the combined DISPAIR-FRS prediction model
Retrospective multicentre cohort including 2284 patients from nine high-volume pancreatic surgery centers (Europe and North America) who underwent left pancreatectomy since 2010.
The study validated and compared two preoperative risk models for postoperative pancreatic fistula (POPF): DISPAIR and D-FRS.
Both original models showed moderate discrimination (AUC 0.62), prompting development of an updated combined model named DISPAIR-FRS, incorporating additional patient and anatomical factors.
The new model achieved improved performance with an AUC of 0.72 and good calibration across centers.
DISPAIR-FRS provides a more accurate preoperative tool for POPF risk prediction and is publicly accessible at www.tinyurl.com/the-dispair-frs.
______
BJS Open highlights:
______
Predicting postoperative pancreatic fistula after robotic pancreatoduodenectomy
Pancreatic surgery remains central to improving outcomes in pancreatic cancer, yet postoperative pancreatic fistula (POPF) remains a challenge. In this large European multicentre study from the E-MIPS consortium, Emmen et al. evaluated established fistula risk scores after robotic pancreatoduodenectomy in more than 900 patients. Clinically relevant POPF occurred in 22 per cent of cases. The International Study Group for Pancreatic Surgery, International Study Group for Pancreatic Surgery 3-tier, fistula risk scores and alternative-fistula risk scores underestimated the risk of postoperative pancreatic fistula. In contrast, the updated alternative-fistula risk score was well-calibrated at low predicted risks, but overestimated postoperative pancreatic fistula risk for high-risk patients. Accurate risk prediction remains essential for prevention, patient counselling, and benchmarking outcomes. Read paper.
______
Anatomically resectable versus biologically borderline resectable pancreatic cancer definition: refining the border beyond anatomical criteria and biological aggressiveness
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive malignancies, and even patients with anatomically resectable disease exhibit heterogeneous outcomes. In this large single-institution study of 886 resected patients, Belfiori et al. identified a subgroup of “biologically borderline resectable” PDAC—characterized by elevated CA19-9, prolonged cancer-related symptoms, or radiological lymph node involvement—that showed significantly worse survival despite technical resectability. Median disease-specific survival was 40 months in this biologically adverse group compared with 59 months in standard resectable cases, and only 27 months when treated by upfront surgery alone. These findings underscore that tumour biology, not anatomy alone, determines prognosis and should guide treatment sequencing. Read paper.
______
Neoadjuvant therapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: systematic review and meta-analysis
In this comprehensive meta-analysis of nine randomized trials including 1,194 patients, Dickerson et al. demonstrated that neoadjuvant therapy significantly improves overall (HR 0.73) and progression-free survival (HR 0.80) compared with upfront surgery. The benefit was most pronounced in borderline-resectable disease, where neoadjuvant treatment reduced early progression and doubled the likelihood of achieving node-negative, margin-free (R0) resection. While adverse events were more frequent, these were offset by the improved oncologic outcomes. These findings support neoadjuvant therapy as the standard of care for borderline-resectable pancreatic cancer and reinforce the need for biologically tailored treatment strategies in this lethal disease. Read paper.
.png)
.jpg){kind=logo}
