Citations 2
Impact of preoperative radiotherapy on the risk of postpancreatectomy haemorrhage and major morbidity after resection of pancreatic adenocarcinoma including arterial divestment or arterial resection
Stoop, Thomas F, Land, Freek R. van ‘t , Seelen, Leonard W F, Ali, Mahsoem , Sultan, Ahmer , Javed, Ammar A, Eijck, van, Thiels, Cornelius A, Hewitt, D Brock, Sparrelid, Ernesto, Uzunoglu, Faik G, Gehrisch, O H Fiete, Daams, Freek, Ishida, Hiroyuki, Santvoort, Hjalmar C van, Molenaar, I Quintus, Leiting, Jennifer L. , Cappelle, Marie, Ginesini, Michael, Kendrick, Michael L, Franklin, Oskar , Ghorbani, Poya, Schulick, Richard D, Dankha, Rimon , Wilde, R F de, Welsch, Thilo , Riele, Wouter te, Wolfgang, Christopher L, Koerkamp, Bas Groot , Boggi, Ugo, Truty, Mark J, Chiaro, Marco Del, Hackert, T, Croce, C, Kazemier, G, Rompen, I F, Larsson, P, Franco, S Rodriguez, Sugawara, T, van 't Land, Freek R , Erdmann, Joris I , Busch, Olivier R , Franklin, Oskar , Besselink, Marc G , Groot Koerkamp, Bas , Hackert, Thilo , Sultan, Ahmer , Stoop, Thomas F. , Seelen, Leonard W. F. , Javed, Ammar A. , Thiels, Cornelius A. , Hewitt, D. Brock , Sparrelid, Ernesto , Uzunoglu, Faik Güntac , Gehrisch, O. H. Fiete, Daams, F, Ishida, Hiroyuki, Santvoort, Hjalmar C. van , Molenaar, I. Quintus , Erdmann, Joris I. , Cappelle, Marie , Ginesini, Michael , Kendrick, Michael L. , Napoli, Niccolò , Ghorbani, Poya , Schulick, Richard D. , Wilde, Roeland De, Riele, Wouter W. te , Wolfgang, Christopher L. , Boggi, Ugo , Truty, Mark J. , Chiaro, Marco Del , Hackert, Thilo , Kazemier, Geert , Rompen, Ingmar Florin , Larsson, Patrik , Franco, Salvador Rodriguez
BJS Open | April 16, 2026 | Volume: 10 | Issue: 3 | Pages: No page available
Abstract Background Some centres advocate preoperative radiotherapy in patients with pancreatic cancer and arterial involvement despite a lack of Level 1 evidence on survival benefit. Although it has been suggested that preoperative radiotherapy may increase the risk of postpancreatectomy haemorrhage (PPH) and morbidity, evidence is again lacking. This study investigated the association between preoperative radiotherapy and both PPH and major morbidity following arterial divestment/resection during pancreatic adenocarcinoma resection after chemotherapy. Methods Consecutive patients diagnosed with pancreatic adenocarcinoma and > 180° arterial involvement who were treated with preoperative chemotherapy with or without radiotherapy followed by pancreatic resection with arterial divestment/resection were included in the study. Logistic regression analyses including propensity score-based overlap weighting were performed to investigate associations between radiotherapy and in-hospital PPH grade B/C and major morbidity, expressed as adjusted risk differences (aRDs). Results Overall, 246 patients undergoing pancreatic resection with arterial resection (169, 69%) or divestment (77, 31%) were included. Radiotherapy was not associated with PPH (aRD 6%; 95% confidence interval (c.i.) −3 to 14), regardless of arterial divestment (aRD 3%; 95% c.i. −5 to 11) or arterial resection (aRD 12%; 95% c.i. 1 to 23; Pinteraction = 0.189). Radiotherapy was associated with a 14% (95% c.i. 2 to 25) higher risk of major morbidity, especially after arterial resection (aRD 27%; 95% c.i. 11 to 43) compared with arterial divestment (aRD −12%; 95% c.i. −35 to 11; Pinteraction = 0.006) and after external beam radiotherapy (aRD 21%; 95% c.i. 8 to 32) compared with stereotactic body radiotherapy (aRD −12%; 95% c.i. −27 to 6; Pinteraction = 0.0001). Ninety-day mortality was increased, albeit not significantly, after preoperative radiotherapy (10 (8%) versus 3 (3%) deaths with versus without preoperative radiotherapy, respectively; P = 0.067). Conclusions Radiotherapy before resection of pancreatic cancer with > 180° arterial involvement was associated with an increased risk of postoperative major morbidity when arterial resection, but not arterial divestment, was performed. This risk should be taken into account when considering preoperative radiotherapy in patients who may require arterial resection.
International Reference Values for Surgical Outcomes of Total Pancreatectomy
Berchtold, Caroline , Kuemmerli, Christoph, Li, Zhihao , Eden, Janina , Wu, Pengfei , Cecchetto, Sara Nicole, Kendrick, Michael L. , Pecorelli, Nicolò , Guarneri, Giovanni , Farooqui, Waqas , Tschuor, Christoph , Burgdorf, Stefan Kobbelgaard , Mühlhäusser, Julia , Gass, Jörn‐Markus , Koh, Ye-Xin, Seip, Tomas, Santibañes, Martín de , Todeschini, Letizia , Marchegiani, Giovanni, Belfil, Nadiya , Boggi, Ugo, Cappelle, Marie , Koerkamp, Bas Groot , Dutkowski, Philipp , Hackert, Thilo , Truty, Mark J. , Group, Outcomes for Total Pancreatectomy, Valle, Valentina , Giulianotti, Pier Cristoforo , Pessaux, Patrick, Thapa, Prabin , Kuzman, Matta , Pandanaboyana, Sanjay, He, Jin , Kendrick, Michael, Truty, Mark, Li, Zhihao , Groot Koerkamp, Bas , Müller, Philip C , Breuer, Eva , Vallorani, Alessia , Hansen, Carsten Palnæs , Guidetti, Cristiano , Campbell, Brady A. , Cecchetto, Sara Nicole, Gudmundsdottir, Hallbera , Starlinger, Patrick , Goh, Brian K P , Koh, Ye-Xin , Rebelo, Artur , Kleeff, Jorg H. , Marchegiani, Giovanni , Lesurtel, Mickaël , Machado, Marcel Autran C. , Kauffmann, Emanuele F. , Benedetto, Fabrizio Di , Roberts, Keith John , Nevler, Avinoam , Lavu, Harish , Nickel, Felix , He, Jing , Falconi, Massimo , Billeter, Adrian T. , Müller-Stich, Beat Peter , Group, Outcomes for Total Pancreatectomy, Halle-Smith, James Michael , Giannone, Fabio , Pessaux, Patrick , Sánchez‐Velázquez, Patricia , Maharjan, Dhiresh Kumar , Torres, Orlando Jorge Martins
JAMA Surgery | November 12, 2025 | Volume: 161 | Issue: 1 | Pages: 50
Importance 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. Objective To define reference values for TP based on a low-risk cohort treated at expert centers. Design, Setting, and Participants 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. Exposures TP. Main Outcomes and Measures 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. Results 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). Conclusions and Relevance 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.