A new preoperative risk score based on CT measurements can help surgeons predict clinically relevant postoperative pancreatic fistula (cr-popf) after pancreatoduodenectomy.

• 6-point score achieved an AUC of 0.89; sensitivity 81.8%, specificity 91.7%.
• Incidence of cr-popf varies widely: 4.6% in low-risk vs. 82.5% in very high-risk patients.

Use this scoring system for better surgical planning and targeted prevention strategies.

• Key risk factors include pancreatic attenuation ≤30 Hounsfield units, duct-to-parenchyma ratio ≤0.2, duct diameter <3mm, and BMI ≥25 kg/m².

Neoadjuvant chemotherapy followed by surgery significantly improves outcomes for potentially resectable intrahepatic cholangiocarcinoma compared to upfront surgery.

• Median overall survival is 52.9 months with neoadjuvant therapy versus 37.0 months with upfront surgery.
• Recurrence is delayed (34.6 months vs. 24.4 months) and fewer patients are at risk of death (46.4% vs. 75.3%).
• Five-year survival rates are substantially higher (45.7% vs. 32.5%), indicating a need to revise treatment guidelines.

Consider neoadjuvant chemotherapy especially for patients at high risk of recurrence to enhance surgical outcomes.