R1 resection is linked to significantly worse survival in node-positive pancreatic ductal adenocarcinoma patients.

• R1 status increased the hazard of mortality by 38% (HR 1.38; 95% CI: 1.21-1.59).
• The overall R0 rate in node-positive cases was 61.1%, varying by adherence to the Royal College of Pathology guidelines.

R0 resection should remain a key goal in surgical planning for these patients until more robust evidence regarding R1’s implications emerges.

• R1 resections under RCP guidelines were associated with an HR of 1.25 for poorer outcomes.

Intrathecal morphine is as effective as continuous wound infiltration for pain management after open pancreatoduodenectomy.

• In a study of 92 patients, intrathecal morphine had a mean coughing pain score of 5.7 vs. 6.1 for continuous wound infiltration.
• It provided better early pain relief, significantly reducing pain scores at 2 hours post-op and sustaining lower scores through 24 hours.

Surgeons should consider intrathecal morphine for its effective pain control, but monitor for potential early side effects like respiratory depression and pruritus.

This study shows that robotic remnant total pancreatectomy (r-rtp) after robotic pancreaticoduodenectomy is a feasible option with promising outcomes.

• Mean operative time was 332 minutes, with a blood loss of 168 ml.
• All three patients had R0 resections and are alive without recurrence after the procedure.

No postoperative complications or mortality were reported, indicating a safe approach.

• Patients experienced a postoperative hospital stay averaging 13.3 days.

• In a study of 403 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma, checking pancreatic neck margins with frozen section did not improve recurrence-free or overall survival outcomes.
• Median pancreatic neck recurrence-free survival was longer in patients with negative initial results (23.1 months) vs. those with revision clearance (16.9 months).

Surgical efforts to clear positive margins may lead to worse overall survival outcomes.

• Only 69% of positive frozen sections were resolved with revision, and pursuing completion total pancreatectomy for margin clearance carried risks of recurrence and mortality.

Preoperative chemotherapy in perihilar cholangiocarcinoma shows similar surgical outcomes to those who do not receive it.

• Chemotherapy group had 52% morbidity and 4% mortality, with main complications like surgical site infections (27%) and bile leakage (26%).
• No significant differences in operative time, blood loss, or pathology outcomes after matching 80 patients per group.

Preoperative chemotherapy does not worsen surgical or pathological outcomes, guiding better patient selection.

• Five-year survival rates were nearly identical: 32.7% for the chemotherapy group vs. 30.9% for controls.