Centre Versus Surgeon Volume in Pancreatic Surgery

Background/Objectives: Pancreatic resections have different technical demands and rescue requirements, yet centre and surgeon volume are often treated as interchangeable exposures. Their relative contributions are particularly relevant as robotic pancreatic surgery expands. Methods: PubMed/MEDLINE was searched from inception to 24 August 2026 for systematic reviews, population-based and multilevel studies, failure-to-rescue analyses, consensus statements, learning-curve studies, and randomised or multicentre evidence concerning pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, and robotic pancreatic surgery. Results: Surgeon experience was consistently related to technical execution after pancreatoduodenectomy, whereas centre volume showed an additional association with 90-day mortality, readmission, and failure to rescue. Contemporary interaction analyses indicate that a high-volume surgeon does not reliably compensate for a low-volume hospital. Associations with centre volume were strongest for pancreatoduodenectomy and total pancreatectomy; evidence for standard distal pancreatectomy was less consistent, although high-volume centres achieved lower failure-to-rescue rates. Robotic pancreatoduodenectomy introduced concurrent surgeon, team, and centre learning curves. More favourable outcomes during robotic adoption were reported in established open pancreatic programmes using structured training, proctoring, case selection, and prospective audit. Randomised robotic evidence was generated in credentialled high-volume centres and should not be extrapolated uncritically to early programmes. Conclusions: Pancreatic volume policy should be operation-specific. Surgeon experience is more closely associated with technical performance, whereas centre-level capability is more strongly associated with complication recognition and rescue. Referral and robotic credentialing should therefore integrate procedure-specific experience, audited outcomes, rescue capability, learning-curve status, and access, rather than rely on a single annual threshold.