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Background: Pancreatoduodenectomy in elderly patients may be associated with increased postoperative mortality, but studies in minimally invasive pancreatoduodenectomy (MIPD) are scarce., Methods: International multicenter retrospective study including patients aged >60 years undergoing MIPD (robot-assisted and laparoscopic) and open pancreatoduodenectomy (OPD), were categorized by age: 60-69, 70-79, and 80+ years. In each category, propensity score matching (PSM) was performed (1:1 ratio) between MIPD and OPD. Primary outcome was 30-day/in-hospital mortality., Results: Among 3820 patients, we matched 1468 patients aged 60-69, 1154 patients aged 70-79, and 196 patients aged 80+ years. In patients aged 60-69 and 70-79 years, MIPD was associated with longer operative time, less blood loss and a longer length of stay. Major morbidity was higher after MIPD with similar 30-day/in-hospital mortality. The R0 resection rate was higher after MIPD. In patients aged 80+ years, besides a longer operative time in MIPD, outcomes were comparable between both groups., Conclusion: This study found no evidence that increasing age worsens mortality of MIPD. MIPD was associated with longer operative time, higher rate of major morbidity, prolonged length of stay versus less blood loss and a higher R0 resection in patients aged 60-69 and 70-79 years. These differences continue in patients aged 80+ years, but became less evident., Competing Interests: Conflict of interest LRJ and MGB received funding from the Intuitive Surgical® for the investigator-initiated LEARNBOT study on safe implementation and training of robot pancreatoduodenectomy in Europe. MGB and MAH received funding from Intuitive Surgical® (LEARNBOT 24445; DIPLOMA-2 24904) and Ethicon EndoSurgery (994492729) to support the ongoing quality registry for minimally invasive pancreatic surgery in Europe and from Intuitive Surgical® for the investigator-initiated DIPLOMA-2 randomized trial comparing minimally invasive and open pancreaticoduodenectomy. The other authors have nothing to disclose relevant to this study or manuscript., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers., Background: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking., Methods: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3)., Results: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001)., Conclusions: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.

This article summarizes a study that examined the use of drain fluid amylase levels on the first postoperative day (POD1) to predict the development of postoperative pancreatic fistula (POPF) after pancreatic surgery. The study included 185 patients who underwent pancreaticoduodenectomy between April 2014 and April 2018. The results showed that a POD1 amylase level higher than 1883 U/L had the best accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for predicting POPF. The study suggests that a cut-off point of 1883 U/L for POD1 drain fluid amylase level may be useful in predicting clinically relevant POPF in patients undergoing pancreatic resection. [Extracted from the article]

This article discusses a study that compared the evaluation of tissue samples from patients who underwent pancreaticoduodenectomy (PD) by HPB-specific pathologists and general pathologists. The study found that HPB-specific pathologists had a higher number of lymph nodes dissected and a higher number of metastatic lymph nodes compared to general pathologists. Additionally, the HPB-specific pathologists had a higher rate of positive surgical margins. The study concludes that it is crucial to have HPB-specific pathologists examine specimens for the success of HPB surgeries. [Extracted from the article]

Background/Aim: Since the first pancreaticoduodenectomy (PD) surgeries, mortality, morbidity and length of hospital stay decreased, in return, the number of uncomplicated cases and dissected lymph nodes increased over the years. The aim of our study was to determine the effect of hospital volume on survival, postoperative hospital stay, fistula rate, morbidity rate and the number of lymph nodes dissected. Methods: In this retrospective cohort study, 213 patients who were operated with the diagnosis of periampullary tumor between January 2008 and January 2016 were included in the study. The patients were divided into four groups according to the years of surgery: Group A (n=31, 2008-2009), Group B (n=46, 2010-2011), Group C (n=50, 2012-2013) and Group D (n=86, 2014-2016). The groups were compared with each other in terms of the following factors; Pancreatic fistula rates, postoperative hospital stay, mortality rates, morbidity rates, number of dissected lymph nodes. Results: It has been observed that there is a relation between pancreatic tissue quality and duct size with fistulas (P=0.0016 and P=0.017, respectively). It is seen that as the amount of number lymph nodules increases, the quality of staging improves (P=0.009). Rates of mortality and morbidity are decreased, as the hospital volume increased (P=0.037), The same effect of hospital volume is observed in length of hospital stay and fistula rates, both improved (P=0.017 and P<0.001, respectively). Conclusion: It is easy to state that the increase in hospital volume and surgeon's experience is directly related with patient outcomes. As the understanding of anatomy increases, quality of the surgery is assumed to be increased as well as the reduction in length of hospital stay, mortality and morbidity rates, and the increase in quantity of dissected lymph nodules. [ABSTRACT FROM AUTHOR]

Brunner's Gland Adenoma is a very rarely seen benign tumor of duodenum. While it generally leads to obstruction and bleeding complaints, it may very rarely occur by mimicking a pancreatic tumor. A 48 years old male patient admitted to the gastroenterology clinic due to the epigastric pain spreading dorsally. No significant feature is present in his clinical history. A lesion containing cystic solid components in the size of 30x40 mm was detected in the head of pancreas as a result of the abdominal tomography. In the light of these findings, pancreaticoduodenectomy is applied to the patient. It is observed that tumor is in submucosal location and widely invaded the pancreatic head. In the histopathological examination, Brunner's Gland Adenoma is reported in pancreatic head localization. In this manuscript a case of Brunner's gland adenoma diagnosed by performing pancreaticoduodenectomy due to the mass in the head of the pancreas is presented. [ABSTRACT FROM AUTHOR]