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Published on: March 17, 2026
Activity and Physiological Stress Within 90 Days After Minimally Invasive and Open Pancreatoduodenectomy: A
Caro L Bruna1,2, Anouk M L H Emmen1,2, Nine de Graaf1,2
1Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
Importance:
Minimally invasive pancreatoduodenectomy (MIPD) aims to improve postoperative recovery compared with open pancreatoduodenectomy (OPD). However, it is unclear whether the benefits of MIPD extend beyond the initial hospital stay.
Objective:
To assess postoperative recovery after hospital discharge-using activity tracking-in patients with upfront resectable neoplasm in the pancreatic head or periampullary region, comparing MIPD with OPD.
Design, Setting, And Participants:
The patient-blinded DIPLOMA-2 randomized clinical trial was conducted between 2022 and 2023. This was an international, multicenter trial in 14 high-volume centers in 6 European countries. Included in the analysis were patients with suspected or proven upfront resectable neoplasm (ie, without vascular contact) in the pancreatic head or periampullary region. Study data were analyzed from January 2024 to January 2025.
Interventions:
Patients were randomly assigned to undergo MIPD or OPD (2:1 ratio). Patients wore an activity tracker (Fitbit Inspire 2 [Google]) from 2 weeks before surgery until 90 days thereafter. The tracker monitored step count, active minutes, and heart rate variability (HRV), wherein high HRV reflects parasympathetic activity and thus physiological relaxation and recovery.
Main Outcomes And Measures:
Postoperative physical activity in the first 90 postoperative days.
Results:
A total of 288 patients (mean [SD] age, 68.3 [9.9] years; 168 male [58.3%]) were included in this analysis. Activity tracker data were available from 236 of 288 patients (82%; 155 in the MIPD and 81 in the OPD groups). On postoperative day 30, patients in the MIPD group averaged 659 more steps daily (95% CI, 79-1240 steps; P = .03), had 22 more active minutes daily (95% CI, 3-40 minutes; P = .03), and had a 9-millisecond higher HRV (95% CI, 2-15 milliseconds; P = .006), compared with the OPD group. On postoperative day 90, step count and active minutes were comparable between groups, but HRV remained higher in the MIPD group. Patients after MIPD had a significantly higher step count between postoperative day 16 and 39 and more active minutes between day 14 and 37.
Conclusions And Relevance:
In this randomized clinical trial, activity tracking up to 90 days revealed increased physical activity up to 5 weeks after MIPD and less physiological stress up to 3 months, as compared with OPD. Future studies should confirm whether these relatively modest benefits persist in other settings, such as lower-volume centers.
Trial Registration:
ISRCTN.org Identifier: ISRCTN27483786.
Insights
Minimally invasive pancreatoduodenectomy (MIPD) shows improved physical activity and reduced physiological stress for up to 90 days compared to open pancreatoduodenectomy (OPD). These benefits in recovery after pancreatic surgery suggest MIPD offers advantages beyond initial hospital discharge.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreatoduodenectomy (MIPD) is proposed to enhance postoperative recovery over open pancreatoduodenectomy (OPD).
- Evidence regarding the long-term recovery benefits of MIPD beyond hospital discharge remains limited.
Purpose of the Study:
- To compare postoperative recovery between MIPD and OPD using activity tracking up to 90 days post-discharge.
- To assess physical activity and physiological stress in patients undergoing pancreatic head or periampullary neoplasm resection.
Main Methods:
- A patient-blinded, randomized clinical trial (DIPLOMA-2) involving 288 patients across 14 European centers.
- Patients were randomized to MIPD or OPD (2:1 ratio) and wore activity trackers monitoring steps, active minutes, and heart rate variability (HRV).
Main Results:
- MIPD patients showed significantly higher daily step counts (+659 steps) and active minutes (+22 minutes) at postoperative day 30 (P=.03).
- Heart rate variability (HRV), indicating physiological relaxation, was significantly higher in the MIPD group at day 30 (+9 ms; P=.006) and remained elevated at day 90.
- Increased physical activity persisted for MIPD patients up to 5 weeks, with enhanced recovery markers up to 3 months post-surgery.
Conclusions:
- Activity tracking demonstrates that MIPD leads to greater physical activity and reduced physiological stress for up to 3 months post-discharge compared to OPD.
- The findings suggest that the recovery advantages of MIPD extend beyond the immediate postoperative period.
- Further research in diverse settings is recommended to validate these findings.
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