Pancreatic surgery: evolution and current tailored approach

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Pancreatic Diseases

Background:

• Pancreatic cancer resection is the only curative treatment, yet it carries significant risks.
• Pancreatic fistulas are the most common and serious postoperative complication following pancreaticoduodenectomy.
• Understanding risk factors and preventative strategies is crucial for improving patient outcomes.

Purpose of the Study:

• To review current knowledge on pancreatic fistula prevention and management after pancreaticoduodenectomy.
• To discuss pharmacological and technical interventions for preventing pancreatic leakage.
• To address controversies in the management of the pancreatic remnant post-resection.

Main Methods:

• Comprehensive literature review of studies on pancreatic fistula.
• Analysis of risk factors, prophylactic measures, and management strategies.
• Discussion of surgical techniques and postoperative care advancements.

Main Results:

• Risk factors for pancreatic fistula are well-established.
• Various prophylactic pharmacological and technical measures exist for prevention.
• Most pancreatic fistulas can be managed conservatively with advanced care and interventions.

Conclusions:

• Effective management of pancreatic fistulas relies on understanding risk factors and employing preventative strategies.
• Conservative management is often successful for common complications.
• Optimal pancreatic remnant management remains a subject of ongoing debate and research.