Evolving Surgical Approaches in the Management of Pancreatic Masses: From Open Resection to Minimally Invasive and...

Pancreatic masses represent a heterogeneous spectrum of neoplasms, ranging from benign lesions such as serous cystadenomas to malignant tumors such as pancreatic ductal adenocarcinoma (PDAC). Timely and accurate differentiation among these entities is essential for devising effective therapeutic strategies. Recent advancements in diagnostic modalities, surgical techniques, and perioperative care have significantly influenced the management of pancreatic masses. This narrative review synthesizes current literature and clinical practices related to the surgical management of pancreatic masses. It examines the evolution of diagnostic tools, operative approaches, perioperative management, and the integration of emerging technologies in clinical decision-making. Imaging modalities such as contrast-enhanced CT, MRI, and endoscopic ultrasound have improved the precision of diagnosis and staging. Histopathological confirmation remains the gold standard for definitive diagnosis. Surgical options, including partial and total pancreatectomy, are tailored according to tumor type and stage, with resection being the only curative treatment for PDAC. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, offer the benefits of reduced morbidity and faster recovery while maintaining oncological outcomes. Neoadjuvant therapy shows promise in enhancing surgical success and survival in resectable and borderline resectable tumors. Postoperative complications such as pancreatic fistulas, delayed gastric emptying, and endocrine/exocrine insufficiencies are common challenges. For non-resectable tumors, palliative options such as biliary bypass and endoscopic stenting focus on symptom relief and quality of life. The surgical management of pancreatic masses has evolved significantly, driven by advancements in diagnostics, minimally invasive techniques, and supportive perioperative care. Emerging tools such as intraoperative imaging, artificial intelligence, and precision medicine are enabling more personalized treatment plans. A multidisciplinary approach remains critical in optimizing outcomes for patients with pancreatic neoplasms.