Surgeons now have a validated definition of a textbook outcome for distal pancreatectomy, which influences patient selection and post-operative management.

• Textbook outcomes include no readmissions or deaths within 90 days, length of stay below the 75th percentile, no major complications, and negative margins.
• In a study of 339 patients, only 46.3% achieved this outcome; major complications significantly impacted 180-day mortality (odds ratio 0.04, p = .009).

Defining these outcomes can guide surgical decisions and enhance patient care, particularly for those with adenocarcinoma, where a shorter time to adjuvant therapy was observed for patients meeting textbook criteria (1.47 vs. 2.56 months, p < .001).

Robotic pancreatoduodenectomy has greater postoperative complication risks than laparoscopic, especially after conversion.

• Major morbidity rates are 49% in robotic (rpd) versus 31% in laparoscopic (lpd) after conversion (p=0.021).
• Conversion required in 12% of cases, with no significant difference between robotic (12%) and laparoscopic (14%).

Surgeons should assess conversion risks when choosing robotic methods, emphasizing structured decision-making protocols and team training.

• In high-volume centers, occurrences of major morbidity and pancreatic-specific complications are notably higher in robotic cases.

Patients with biological borderline resectable pancreatic cancer and CA19-9 levels ≥500 u/ml show worse outcomes and need tailored surgical approaches.

• Cancer-specific survival is significantly lower in patients with CA19-9 ≥500 u/ml compared to those with levels <37 u/ml (p = 0.03).
• Higher CA19-9 is linked to increased genomic mutations, with tumors showing ≥3 driver gene alterations rising along CA19-9 strata (ptrend = 0.01).
• The presence of tertiary lymphoid structures and CD8+ T-cell density decreases as CA19-9 increases, indicating an immunosuppressive environment.

Recognizing CA19-9 ≥500 u/ml may guide more aggressive management strategies for these high-risk patients.