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New Insights into Pancreatic Surgery
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New Insights into Pancreatic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 11546

Special Issue Editors

Prof. Dr. Mario Serradilla-Martín

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Guest Editor
Division of HPB Surgery & Liver Transplantation, Hospital Universitario Virgen de las Nieves, Granada, Spain
Interests: pancreatic cancer; pancreatic cystic tumors; IPMN; IPNB; acute pancreatitis; chronic pancreatitis; cholangiocarcinoma; hepatocellular carcinoma; liver metastases; liver transplantation; minimally invasive surgery
Prof. Dr. José Manuel Ramia

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Guest Editor
Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, Spain
Interests: pancreatic cancer; pancreatic cystic tumors; IPMN; IPNB; acute pancreatitis; chronic pancreatitis; cholangiocarcinoma; hepatocellular carcinoma; liver metastases; liver transplantation; minimally invasive surgery

Special Issue Information

Dear Colleagues,

The number of pancreatic surgeries is increasing every year. There are several reasons, but the most remarkable are the increase in diagnosed pancreatic cancers and the more frequent diagnosis of other pancreatic diseases for which surgery is now considered as an option due to their possibility of malignancy transformation. This has meant that surgical indications have expanded steadily. The main problems facing pancreatic surgery are the high incidence of postoperative major complications and the low but remarkable mortality. The centralization in high-volume centers; technical advances, such as minimally invasive surgery approaches, including robotic surgery; and the standardization of surgical procedures have decreased the complication rates. However, more complex cases (patients with arterial involvement or neoadjuvant chemotherapy) are evaluated daily. Surgeons had also implemented several healthcare tools to measure and improve surgical results (textbook outcomes, failure to rescue, benchmarking, fistula risk scores, etc.). In this Special Issue, we invite authors to submit papers about all surgical topics that allow readers to increase their knowledge about treating patients with pancreatic surgical diseases.

Prof. Dr. Mario Serradilla-Martín
Prof. Dr. José Manuel Ramia
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreas
  • pancreatectomy
  • surgery
  • outcomes
  • cancer
  • fistula
  • minimally invasive surgery
  • IPMT

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Published Papers (6 papers)

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Research

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12 pages, 634 KB  
Article
Effect of Volume on Postoperative Outcomes After Left Pancreatectomy: A Multicenter Prospective Snapshot Study (SPANDISPAN Project)
by Daniel Aparicio-López, José M. Ramia, Celia Villodre, Juan J. Rubio-García, Belén Hernández, Juli Busquets, Luis Secanella, Nuria Peláez, Maialen Alkorta, Itziar de-Ariño-Hervás, Mar Achalandabaso, Enrique Toledo-Martínez, Fernando Rotellar, Pablo Martí-Cruchaga, Miguel A. Gómez-Bravo, Gonzalo Suárez-Artacho, Marina Garcés-Albir, Luis Sabater, Gabriel García-Plaza, Francisco J. Alcalá, Enrique Asensio, David Pacheco, Esteban Cugat, Francisco Espín, María Galófre-Recasens, Belinda Sánchez-Pérez, Julio Santoyo-Santoyo, Jorge Calvo, Carmelo Loinaz, María I. García-Domingo, Santiago Sánchez-Cabús, Belén Martín-Arnau, Gerardo Blanco-Fernández, Isabel Jaén-Torrejimeno, Carlos Domingo-del-Pozo, Carmen Payá, Carmen González, Eider Etxebarría, Rafael López-Andújar, Cristina Ballester, Ana B. Vico-Arias, Natalia Zambudio-Carroll, Sergio Estévez, Manuel Nogueira-Sixto, José I. Miota, Belén Conde, Miguel A. Suárez-Muñoz, Jorge Roldán-de-la-Rua, Angélica Blanco-Rodríguez, Manuel González, Pilar E. González-de-Chaves-Rodríguez, Betsabé Reyes-Correa, Santiago López-Ben, Berta Tió, Javier Mínguez, Inmaculada Lasa-Unzué, Alberto Miyar, Lorena Solar, Fernando Burdío, Benedetto Ielpo, Alberto Carabias, María P. Sanz-Muñoz, Alfredo Escartín, Fulthon Vela, Elia Marqués, Adelino Pérez, Gloria Palomares, Antonio Calvo-Córdoba, José T. Castell, María J. Castro, María C. Manzanares, Enrique Artigues, Juan L. Blas, Luis Díez, Alicia Calero, José Quiñones, Mario Rodríguez, Cándido F. Alcázar-López and Mario Serradilla-Martínadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(17), 6013; https://doi.org/10.3390/jcm14176013 - 25 Aug 2025
Abstract
Background/Objectives: Like many other countries, the management of pancreatic cancer in Spain has developed in a fragmented manner. This study analyzes clinical outcomes related to patient volume at different centers after left pancreatectomy (LP). Our goal is to determine whether our practices align [...] Read more.
Background/Objectives: Like many other countries, the management of pancreatic cancer in Spain has developed in a fragmented manner. This study analyzes clinical outcomes related to patient volume at different centers after left pancreatectomy (LP). Our goal is to determine whether our practices align with the standards established in the literature and assess whether centralization’s advantages significantly outweigh its disadvantages. Methods: The SPANDISPAN Project (SPANish DIStal PANcreatectomy) is an observational, prospective, multicenter study focused on LP conducted in Spanish Hepato-Pancreato-Biliary (HPB) Surgery Units from 1 February 2022 to 31 January 2023. HPB units were defined as high volume if they performed more than 10 LPs annually. Results: This study included 313 patients who underwent LP at 42 centers across Spain over the course of a year. A total of 40.3% of the procedures were performed in high-volume centers. Significant differences in preoperative variables were only observed in ASA scores, which were higher in the high-volume group. Intraoperatively, minimally invasive surgical techniques were performed more frequently in high-volume centers. Postoperatively, the administration of somatostatin, major complications, and B and C postoperative pancreatic fistula (POPF) were more frequent in low-volume hospitals. Conclusions: The findings revealed that high-volume centers had a higher rate of minimally invasive surgery, lower intraoperative bleeding, fewer complications, and reduced POPFs compared to low-volume centers. However, it is important to note that low-volume centers still demonstrated acceptable outcomes. Thus, the selective referral of more complex laparoscopic procedures could initiate a gradual centralization of surgical practices. Full article
(This article belongs to the Special Issue New Insights into Pancreatic Surgery)
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10 pages, 1095 KB  
Article
Positive Lymph Nodes Independently Affect Long-Term Survival After Pancreaticoduodenectomy for Non-Ampullary Duodenal Adenocarcinoma: A Single-Center, Retrospective Analysis
by Matteo De Pastena, Caterina Costanza Zingaretti, Salvatore Paiella, Gabriella Lionetto, Massimo Guerriero, Nicoletta De Santis, Claudio Luchini, Giuseppe Malleo and Roberto Salvia
J. Clin. Med. 2025, 14(8), 2616; https://doi.org/10.3390/jcm14082616 - 11 Apr 2025
Viewed by 671
Abstract
Background/Objectives: The main treatment for non-ampullary duodenal adenocarcinoma (NDA) is pancreatoduodenectomy (PD) with lymphadenectomy (LN). Several studies have proposed a minimum number of examined lymph nodes (MNELN) to ensure proper staging. This study investigated the impact of nodal parameters—including the pattern of [...] Read more.
Background/Objectives: The main treatment for non-ampullary duodenal adenocarcinoma (NDA) is pancreatoduodenectomy (PD) with lymphadenectomy (LN). Several studies have proposed a minimum number of examined lymph nodes (MNELN) to ensure proper staging. This study investigated the impact of nodal parameters—including the pattern of nodal spread—on oncologic outcomes following PD for NDA. Furthermore, we sought to determine the MNELN to ensure reliable detection of nodal involvement. Methods: This was a single-center, retrospective study. Consecutive patients who underwent PD from 2000 to 2019 with a final diagnosis of NDA were retrieved from a prospectively maintained database. The probability of detecting at least one metastatic LN in a node-positive patient was assessed using a model based on the binomial probability law. Results: A total of 70 patients met the inclusion criteria. The median number of ELNs was 35 (22–43, IQR). Thirty-six patients (51%) had at least one PLN. A node-positive disease was associated with adverse pathologic features, including high tumor grade and perineural and peripancreatic fat invasion. This translated into a greater recurrence rate (p < 0.001). The MNELN yielding a 95% probability of detecting at least one metastatic node in a node-positive patient was 25. After a median follow-up of 73 months, the median recurrence-free survival (RFS) was 33 months (95% CI 13–97), and the overall survival (OS) was 41 months (95% CI 17–96). The LN ratio, tumor grade, and metastases at stations 8 and 12 were independently associated with OS (p < 0.05). Conclusions: Nodal metastases are common among patients with NDA and have a considerable impact on long-term survival. Stations 8 and 12 were associated with OS. Therefore, an adequate lymphadenectomy, possibly including stations 8 and 12, is recommended in patients with NDA. Full article
(This article belongs to the Special Issue New Insights into Pancreatic Surgery)
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11 pages, 886 KB  
Article
Pushing the Boundaries of Ampullectomy for Benign Ampullary Tumors: 25-Year Outcomes of Surgical Ampullary Resection Associated with Duodenectomy or Biliary Resection
by Maria Sorribas, Thiago Carnaval, Luis Secanella, Núria Peláez, Silvia Salord, Joan B. Gornals, David Leiva, Teresa Serrano, Joan Fabregat and Juli Busquets
J. Clin. Med. 2024, 13(23), 7220; https://doi.org/10.3390/jcm13237220 - 27 Nov 2024
Cited by 1 | Viewed by 1228
Abstract
Background: Surgical resection for ampullary lesions lacks clear guidelines. Pancreaticoduodenectomy (PD) is the standard treatment for malignant ampullary tumors but is often excessive for ampullary adenomas (AAs) due to its high morbidity and mortality. Transduodenal ampullectomy (TDA) is generally reserved for small benign [...] Read more.
Background: Surgical resection for ampullary lesions lacks clear guidelines. Pancreaticoduodenectomy (PD) is the standard treatment for malignant ampullary tumors but is often excessive for ampullary adenomas (AAs) due to its high morbidity and mortality. Transduodenal ampullectomy (TDA) is generally reserved for small benign lesions where endoscopic treatment fails, but its role in early ampullary cancers is debatable. This study presents our 25-year outcomes with TDA for benign ampullary tumors. Methods: We conducted a retrospective cohort study with prospectively collected data from patients with benign ampullary lesions who underwent TDA between January 1996 and November 2023. Primary outcomes were the 30-day overall and severe (Clavien–Dindo ≥ IIIa) morbidity rates and the 90-day mortality rate. Categoric variables were presented as absolute and relative frequencies, and quantitative variables were presented as means (standard deviation, SD) or medians (range or interquartile range, IQR). Results: Fifty-three patients (29 male; mean [SD] age 62.5 [14.6] years) underwent TDA. The 30-day morbidity rate was 32.1% (17/53 patients), with five (9.4%) cases being severe. The 90-day mortality rate was 1.9%. Definitive histopathology identified 38 (71.7%) AAs and five (9.4%) infiltrating ampullary adenocarcinomas, two (40.0%) of which required subsequent PD. Six (11.3%) patients experienced recurrence. Overall, nine (16.9%) patients died. Conclusions: TDA is a safe and effective technique with acceptable morbidity for non-infiltrating lesions, especially in patients with poor clinical status. Choosing between TDA and PD depends on tumor size, dysplasia grade, and institutional expertise. Lifelong endoscopic surveillance post-TDA is essential for timely recurrence detection. Full article
(This article belongs to the Special Issue New Insights into Pancreatic Surgery)
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13 pages, 573 KB  
Article
A Comparison of Preoperative Predictive Scoring Systems for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy Based on a Single-Center Analysis
by Naomi Verdeyen, Filip Gryspeerdt, Luìs Abreu de Carvalho, Pieter Dries and Frederik Berrevoet
J. Clin. Med. 2024, 13(11), 3286; https://doi.org/10.3390/jcm13113286 - 3 Jun 2024
Cited by 4 | Viewed by 1877
Abstract
Background: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is associated with major postoperative morbidity and mortality. Several scoring systems have been described to stratify patients into risk groups according to the risk of POPF. The aim of this study was to compare [...] Read more.
Background: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is associated with major postoperative morbidity and mortality. Several scoring systems have been described to stratify patients into risk groups according to the risk of POPF. The aim of this study was to compare scoring systems in patients who underwent a PD. Methods: A total of 196 patients undergoing PD from July 2019 to June 2022 were identified from a prospectively maintained database of the University Hospital Ghent. After performing a literature search, four validated, solely preoperative risk scores and the intraoperative Fistula Risk Score (FRS) were included in our analysis. Furthermore, we eliminated the variable blood loss (BL) from the FRS and created an additional score. Univariate and multivariate analyses were performed for all risk factors, followed by a ROC analysis for the six scoring systems. Results: All scores showed strong prognostic stratification for developing POPF (p < 0.001). FRS showed the best predictive accuracy in general (AUC 0.862). FRS without BL presented the best prognostic value of the scores that included solely preoperative variables (AUC 0.783). Soft pancreatic texture, male gender, and diameter of the Wirsung duct were independent prognostic factors on multivariate analysis. Conclusions: Although all predictive scoring systems stratify patients accurately by risk of POPF, preoperative risk stratification could improve clinical decision-making and implement preventive strategies for high-risk patients. Therefore, the preoperative use of the FRS without BL is a potential alternative. Full article
(This article belongs to the Special Issue New Insights into Pancreatic Surgery)
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Review

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18 pages, 1138 KB  
Review
Updates in Immunotherapy for Pancreatic Cancer
by Robert Connor Chick and Timothy M. Pawlik
J. Clin. Med. 2024, 13(21), 6419; https://doi.org/10.3390/jcm13216419 - 26 Oct 2024
Cited by 5 | Viewed by 3377
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with limited effective therapeutic options. Due to a variety of cancer cell-intrinsic factors, including KRAS mutations, chemokine production, and other mechanisms that elicit a dysregulated host immune response, PDAC is often characterized by poor immune [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with limited effective therapeutic options. Due to a variety of cancer cell-intrinsic factors, including KRAS mutations, chemokine production, and other mechanisms that elicit a dysregulated host immune response, PDAC is often characterized by poor immune infiltration and an immune-privileged fibrotic stroma. As understanding of the tumor microenvironment (TME) evolves, novel therapies are being developed to target immunosuppressive mechanisms. Immune checkpoint inhibitors have limited efficacy when used alone or with radiation. Combinations of immune therapies, along with chemotherapy or chemoradiation, have demonstrated promise in preclinical and early clinical trials. Despite dismal response rates for immunotherapy for metastatic PDAC, response rates with neoadjuvant immunotherapy are somewhat encouraging, suggesting that incorporation of immunotherapy in the treatment of PDAC should be earlier in the disease course. Precision therapy for PDAC may be informed by advances in transcriptomic sequencing that can identify immunophenotypes, allowing for more appropriate treatment selection for each individual patient. Personalized and antigen-specific therapies are an increasing topic of interest, including adjuvant immunotherapy using personalized mRNA vaccines to prevent recurrence. Further development of personalized immune therapies will need to balance precision with generalizability and cost. Full article
(This article belongs to the Special Issue New Insights into Pancreatic Surgery)
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15 pages, 559 KB  
Review
Enhanced Recovery After Surgery (ERAS) in Pancreatic Surgery: The Surgeon’s Point of View
by Fabio Longo, Edoardo Panza, Lorenzo Rocca, Beatrice Biffoni, Chiara Lucinato, Marco Cintoni, Maria Cristina Mele, Valerio Papa, Claudio Fiorillo, Giuseppe Quero, Davide De Sio, Roberta Menghi, Sergio Alfieri and Lodovica Langellotti
J. Clin. Med. 2024, 13(20), 6205; https://doi.org/10.3390/jcm13206205 - 18 Oct 2024
Cited by 3 | Viewed by 3412
Abstract
Pancreatic surgery is complex and associated with higher rates of morbidity and mortality compared to other abdominal surgeries. Over the past decade, the introduction of new technologies, such as minimally invasive approaches, improvements in multimodal treatments, advancements in anesthesia and perioperative care, and [...] Read more.
Pancreatic surgery is complex and associated with higher rates of morbidity and mortality compared to other abdominal surgeries. Over the past decade, the introduction of new technologies, such as minimally invasive approaches, improvements in multimodal treatments, advancements in anesthesia and perioperative care, and better management of complications, have collectively improved patient outcomes after pancreatic surgery. In particular, the adoption of Enhanced Recovery After Surgery (ERAS) recommendations has reduced hospital stays and improved recovery times, as well as post-operative outcomes. The aim of this narrative review is to highlight the surgeon’s perspective on the ERAS program for pancreatic surgery, with a focus on its potential advantages for perioperative functional recovery outcomes. Full article
(This article belongs to the Special Issue New Insights into Pancreatic Surgery)
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