Evidence map›Paper›PMID 41749883›Full record

ReviewCancers2026

Reducing Complications in Pancreaticoduodenectomy.

Josh B Karpes, Ken Liu, Michael D Crawford, Carlo Pulitano, Charbel Sandroussi, Jerome M Laurence

Abstract readReview
In one paragraph

Review in Cancers, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Josh B KarpesDepartment of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia.
Ken LiuAustralian National LT Unit, Royal Prince Alfred Hospital, Sydney 2050, Australia.ORCID 0000-0002-0453-3168
Michael D CrawfordDepartment of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia.
Carlo PulitanoDepartment of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia.
Charbel SandroussiDepartment of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia.
Jerome M LaurenceDepartment of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia.ORCID 0000-0002-1123-0122

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Pancreatic surgery is a technically demanding field associated with frequent morbidity, with pancreatic fistula representing the dominant driver of major complications in pancreaticoduodenectomy (PD). Although refinements in operative technique, perioperative management, and institutional systems have contributed to incremental improvements, the overall incidence of clinically relevant complications has remained largely unchanged over recent decades. This narrative review provides a comprehensive overview of current strategies aimed at reducing morbidity and mortality after pancreaticoduodenectomy, focusing on modifiable technical, pharmacological, nutritional, and systems-based interventions, whilst acknowledging the underlying biological determinants that remain difficult to alter. This review synthesises contemporary evidence on fistula risk modelling, anastomotic reconstruction, and adjunctive operative techniques. The role of pharmacological interventions is examined alongside an evaluation of perioperative nutritional optimisation and enhanced recovery frameworks. Systems-based strategies such as centralisation, failure-to-rescue performance, protocolised pathways, and algorithm-driven postoperative surveillance are highlighted as emerging areas with substantial potential to impact survival independently of complication rates. Finally, this review explores future directions, including radiomics-based risk stratification, intraoperative imaging, and tailored postoperative care. Together, these domains provide a platform for reducing complication severity, standardising postoperative care, and ultimately improving patient outcomes. By integrating these perspectives, this review aims to present a comprehensive and in-depth narrative of how to reduce complications in pancreas surgery. Overall, this narrative review proposes that meaningful improvements in outcomes after PD likely do not arise from the elimination of complications altogether, but rather from improved prediction, prevention where possible, and critically, more effective systems of care that reduce the severity and consequences of complications when they occur.

Indexed as

centralisationfailure to rescuepancreaticoduodenectomypostoperative pancreatic fistula

Identifiers

PMID41749883
PMCPMC12939308

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.