Citations 2
SRS391 - Global outcomes after robotic left pancreatectomy: learning curve, morbidity, and oncological quality
Malik, Abdullah , Chikkala, Bhargav, Heslin, Ryan, Tingle, Samuel, Ramage, Claire, Kho, Jason , Hamady, Zaed, Arshad, Ali, Bari, Hassaan, Sheel, Andrea , Baron, Ryan, Dunne, Declan, Pencaval, Timothy, Lahiri, Rajiv, Bhogal, Ricky H. , Kotecha, Krishna , Samra, Jas, Mittal, A, González, C. , Timmermann, Lea , Pratschke, Johann, Hor, Hoe Yan , Tan, Po Hong, French, Jeremy , Ahmad, Jawad, Ramia, Jose, White, Steven, Pandanaboyana, Sanjay, Chikkala, Bhargava Ram , Hamady, Zaed Z. R. , Arshad, Ali, Bari, Hassaan , Baron, Ryan, Dunne, Declan, Samra, Jas , Mittal, Anubhav, Ausania, Fabio , Pratschke, Johann , Fong, Zhi Ven , Ahmad, Jawad , Ramia, José Manuel
British Journal of Surgery | March 27, 2026 | Volume: 113 | Issue: Supplement_2 | Pages: No page available
Abstract Background Robotic left pancreatectomy (RLP) is increasingly adopted worldwide. Current guidelines suggest a learning curve of 21 cases, yet its impact on major morbidity and oncological quality remains uncertain. Methods A retrospective multicentre international study was undertaken across 10 centres in the UK, Spain, Germany, the USA, and Australia (2014–2025). Consecutive patients undergoing RLP were categorised into competency (first 21 cases per centre) or proficiency phase (>21). The primary outcome was major morbidity (Clavien–Dindo grade ≥ IIIa), and secondary outcome was the R1-margin rate. Mixed-effects logistic regression and risk-adjusted cumulative sum (RA-CUSUM) analyses were performed. Results 521 patients underwent RLP, including 200 (38.4%) in the competency phase and 321 (61.6%) in the proficiency phase. Median age was 63 years (IQR 54–73), and 56.4% were female. Rates of major morbidity were similar between phases (14.5% versus 14.0%, P = 0.981), as were R1 margin rates (21.6% versus 19.7%, P = 0.092). Independent predictors of major morbidity included male sex (OR 1.76, P = 0.037), preoperative pancreatitis (OR 2.23, P = 0.031), and multivisceral resection (OR 2.29, P = 0.034). Among patients with adenocarcinoma (n = 110), prolonged operative time (OR 1.39 per hour, P = 0.004) and nodal positivity (OR 2.62, P = 0.047) predicted R1 resection, while learning phase was not associated with margin status. RA-CUSUM demonstrated no excess morbidity over time in any centre. Conclusions In this first multicentre international analysis, the learning phase of RLP did not increase the risk of major morbidity or compromise oncological quality. These findings support the safe global adoption of RLP with appropriate training and case selection.
Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms
Haugk, Beate , White, Steven, Marchegiani, Giovanni, Holmberg, Marcus, Zerbi, Alessandro, Lu, Zipeng , Inoue, Y., Choi, Munseok , Kang, Chang Moo, Visser, B., Corpelijn, Lieke, Andersson, Bodil, Bereza-Carlson, Paulina, Björnsson, Bergthor, Wennerblom, Johanna, Goh, Brian K. P., Hartman, V., Ahmad, Syed, Patel, Sameer, Berrevoet, Frederik, Mortensen, Kim Erlend, Roberts, K., Lynch, Calum, Gupta, Amit, Kleeff, Joerg, Addeo, Pietro, Friess, Helmut, Koea, Jonathan, Gomez, Dhanny , Gordon-Weeks, Alex, Doria, Cataldo, Tzimas, Georgios, Franklin, O., Månsson, C., Cabús, Santiago Sánchez, Bhogal, Ricky H. , Pathak, Samir, Honselmann, Kim Christin, Balakrishnan, Anita, Mann, Kulbir , Gill, Anthony J., Mittal, A, Samra, Jas, Athwal, Tejinderjit, Loveday, Benjamin, Bhardwaj, Neil, Menon, Krishna, Thapa, Prabin, Matsumoto, Ippei, Jamieson, Nigel, Rebours, Vinciane, Descourvières, Clémence, Davidson, BR, Soreide, Kjetil, Pandanaboyana, Sanjay, Collaborative, Adeno-IPMN2, Kumar, Ajit, González, Carol Natalia Clavijo, Lam, Shi, L’Official-German, Ivan, Bergner, Tina, Rosso, Edoardo , Giulianotti, Pier Cristoforo , Morreau, Mathew , Dili, Alexandra, Sotiropoulou, Maria , Kuzman, Matta , Büyükkasap, Ahmet Çağrı, Uludağ, Gökhan, McGuigan, Mari-Claire , Chouari, Tarak , Dogul, Ahmet, Doğu, Doğukan , Rebelo, Artur, Holewik, Franziska Bernadette, Plesa-Furda, Roxana, Revoredo, Fernando, Galanis, Ilias , Maharjan, Dhiresh, Ghorbani, Poya , Lind, Max, Ami, Katsuya , Vijayashanker, Aarathi , Alsaoudi, Tareq , Lundgren, Linda , Ellisa, Katrina, Hong, Paul , Gupta, Archit, MartinXu, Congde, Konstantoudakis, Georgios, Christophides, Thalis, Spurring, Eleanor Margaret, Iwao, Yasuhito, Pirklc, Martin, Vaitha, Ruhi , Tiwari, Navneet, Sheel, Andrea, Kotecha, Krishna , Stavrou, Gregor A., Patel, Rikhilroy, Misca, Mihaela , Hammond, John, Roalso, Marcus Thomas Thor, Soomro, Faiza H, Halimi, Asif , Kendall, Timothy, Patel, Visad, Stankic, Dunja, Dries, Pieter , Hein, Charlotte, Betram, Julia, Jacob, Rosetta, Wilson, Gregory, Redas, Souheil, Poškus, Augustas, Mosert, Paula Lucia, Šilinskaitė, Ugnė , Hirose, Yuki, Liu, Xue, Standaert, Lars, Kay, Tegan J, Nishida, Kenji, Peddakota, Vivek , Gupta, Amit , Kang, Chang Moo , Ven Fong, Zhi, Kang, Chang Moo , Lucocq, James E. , Marchegiani, Giovanni , Zerbi, Alessandro , Pagnanelli, Michele , Visser, B. , Andersson, Bodil , Bereza‐Carlson, Paulina , Björnsson, Bergþór , Wennerblom, Johanna Hansson , Labori, Knut Jørgen , Goh, Brian K P , Hartman, Vera , Berrevoet, Frederik Christiaan , Ausania, Fabio , Bertrand, Claude , Kleeff, Joerg, Addeo, Pietro , Bellotti, Ruben , Fong, Zhi Ven , Friess, Helmut , Koea, Jonathan , Gordon-Weeks, Alex Nicolas , Doria, Cataldo , Franklin, Oskar , Pathak, Samir , Honselmann, Kim C. , Balakrishnan, Anita , Harrison, Ewen M. , Gill, A J, Mittal, Anubhav, Samra, Jas , Athwal, Tejinderjit , Loveday, Benjamin P. T. , Teh, Catherine , Bhardwaj, Neil , Menon, Krishna, Matsumoto, Ippei , Jamieson, Nigel , Rebours, Vinciane , Søreide, Kjetil , Martlı, Hüseyin Fahri , Roeyen, Geert , Antonakis, Pantelis T. , Bramis, Konstantinos , Hall, Lewis A , Valle, Valentina , Connor, Saxon J. , Kapiris, Stylianos A. , Kerem, Mustafa , Rebelo, Artur , Plesa-Furda, R., Filho, Omero Pereira da Costa , Galanis, Ilias, Konstantoudakis, Georgios, Christophides, Thalis, McGuinness, Matthew James , Yaqub, Sheraz , Pellegrini, Riccardo , Perri, Giampaolo , Sheel, Andrea , Sheen, Amy , Evans, Daisy, Ghamarnejad, Omid , Karavias, Dimitrios D. , Roalsø, Marcus T. T. , Stankic, Dunja , Grubor, Nikica , Gulla, Aistė , Furukawa, Takaaki , Hirose, Yuki , Yin, Lingdi
JAMA Network Open | March 27, 2026 | Volume: 9 | Issue: 3 | Pages: e263688
10.1001/jamanetworkopen.2026.3688
Importance Adjuvant chemotherapy regimens may be administered after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMNs), although the evidence supporting their use is limited. Objective To evaluate the survival benefit associated with contemporary adjuvant chemotherapy regimens after resection in A-IPMNs between 2017 and 2023. Design, Setting, and Participants This retrospective cohort study was an international, multicenter study with 69 participating centers across Europe, North America, South America, and the Asia-Pacific region. Patients undergoing resection for A-IPMNs were included. Data were analyzed from May to August 2025. Intervention Contemporary adjuvant chemotherapy regimens, such as gemcitabine-capecitabine (GemCap); 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX), modified FOLFIRINOX (mFOLFIRINOX), and S-1. Main Outcome and Measure Overall survival (months). Results Among 1321 patients (median [IQR] age 70 [63 to 76] years; 713 males [54.0%] and 608 females [46.0%]), 781 patients (59.1%) received adjuvant chemotherapy, while in 181 patients (13.7%) it was omitted due to poor patient fitness. Of patients who received adjuvant chemotherapy, 568 patients (72.6%) received contemporary regimens, including GemCap (232 patients [29.7%]), FOLFIRINOX (176 patients [22.5%]), mFOLFIRINOX (71 patients [9.1%]), and S-1 (70 patients [9.0%]). The median (IQR) follow-up for the cohort was 64.2 (40.4 to 85.0) months, and the median overall survival was 73.8 months (95% CI, 66.4 to 81.9 months). After 90-day landmark analysis and exclusion of patients ineligible for chemotherapy, adjuvant chemotherapy vs no adjuvant chemotherapy (propensity score–matched populations, 243:243 patients) was not associated with improved overall survival (median, 82.3 months; 95% CI, 78.2 months to not applicable [NA] vs not reached; 95% CI, 75.3 months to NA; P = .58). Contemporary regimens vs no adjuvant chemotherapy (propensity score–matched populations, 309:309 patients) was not associated with longer survival, and a mean survival benefit greater than 4.2 months over 5 years was excluded (difference in restricted mean survival, 1.26 months; 95%, −1.72 to 4.24 months). Treatment outcomes did not vary by chemotherapy regimen or disease characteristic (eg, N stage or carbohydrate antigen 19-9 level). Conclusions and Relevance In this study, contemporary adjuvant chemotherapy was not associated with improved overall survival in A-IPMNs, and a randomized clinical trial is indicated.