Pancreatic Surgery: Current Advances and Future Challenges

Dear Colleagues,

Pancreatic surgery remains one of the most demanding domains of abdominal and oncological surgery. Despite substantial progress in perioperative care, cross-sectional imaging and surgical technology, major resections such as pancreatoduodenectomy and distal pancreatectomy still carry considerable morbidity, with postoperative pancreatic fistula, delayed gastric emptying and post-pancreatectomy hemorrhaging continuing to challenge even high-volume centers. At the same time, the rising global incidence of pancreatic ductal adenocarcinoma, projected to become one of the leading causes of cancer-related mortality within the coming decade, has intensified the need for safer, more effective and more personalized surgical strategies.

The past decade has reshaped the field. Minimally invasive and robotic approaches have progressed from feasibility studies to routine practice, raising important questions about training, learning curves and patient selection. Multimodal treatment, including neoadjuvant chemotherapy and radiotherapy, has expanded the boundaries of resectability and redefined the role of vascular resection and arterial divestment. In parallel, enhanced recovery protocols, prehabilitation and the centralization of care have improved outcomes, while translational research into biomarkers, molecular profiling and precision medicine is beginning to inform both surgical and systemic decisions. Pancreas and islet transplantation continue to evolve as definitive options for selected patients, with ongoing efforts to refine donor selection, graft preservation and the early detection of graft dysfunction.

This Special Issue aims to present and disseminate the most recent advances related to pancreatic surgery, spanning benign and malignant disease, oncological and transplant indications and the full spectrum of open, laparoscopic and robotic techniques. We welcome original research and review articles that address current controversies and anticipate the future challenges of the field.

Topics of interest for publication include, but are not limited to, the following:

• Surgical management of pancreatic ductal adenocarcinoma and other pancreatic neoplasms.
• Minimally invasive and robotic pancreatic surgery, including learning curves and training.
• Prevention and management of postoperative pancreatic fistula and other complications.
• Neoadjuvant and multimodal treatment and its impact on surgical outcomes.
• Borderline resectable and locally advanced disease, including vascular resection and arterial divestment.
• Enhanced recovery, prehabilitation and perioperative optimization.
• Pancreas and islet transplantation, graft preservation and early detection of graft dysfunction.
• Biomarkers, molecular profiling and precision medicine in pancreatic disease.
• Surgical outcomes, quality metrics and centralization of pancreatic care.

Dr. Emanuel Vigia
Guest Editor

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