Intraoperative radiation therapy (IORT) may significantly improve outcomes for patients with borderline resectable and locally advanced pancreatic cancer undergoing pancreatectomy.

• Local recurrence-free survival at 24 months improved to 79% with IORT vs. 53% without (p = .049).
• Overall survival at 24 months was 58% for IORT patients compared to 43% for controls (p = .058).

These findings suggest IORT offers better local control without increasing complications, supporting its consideration in surgical practice.

• Major complications were similar: 10% in IORT vs. 21% in controls.

A new vein-guided technique for laparoscopic right hepatectomy offers better outcomes for selected patients.

• A caudal, vein-guided approach improves anatomic orientation and the transection plane.
• Left semidecubitus positioning enhances exposure, making surgery safer.

Improved techniques focus on minimizing trauma to hepatic structures.

• Post-transection mobilization reduces traction on critical veins, promoting safer resection.

Early-career surgeons can safely and efficiently transition to robotic pancreaticoduodenectomy, achieving proficiency by case 23.

• Mean operative time dropped from 524 to 309 minutes (p < 0.001).
• Clinically relevant pancreatic fistula rates fell from 31.8% to 5.4% (p = 0.012).

Emphasis on mentorship in high-volume settings is crucial for successful outcomes.

• Conversion to open surgery occurred in just 3.8% of cases, with no 90-day mortality.

Surgeons treating T1 ampullary cancer need to consider high upstaging rates and significant survival disparities based on pathologic classification.

• In this cohort of 244 T1 ampullary cancer patients, 75% underwent resection, but 68% were upstaged to higher T classifications post-surgery.
• Five-year overall survival rates were starkly different: 36% for clinical T1N0 vs. 75% for pathologic T1N0 patients.

Given these findings, pancreatoduodenectomy is recommended over local resection for better outcomes.

• Independent predictors for poor survival include pathologic N1 (HR: 2.12) and poorly differentiated tumors (HR: 4.05).

A recent study highlights the critical need to adjust how we identify and manage chyle leak after pancreatic surgery.

• Chyle leak occurred in 11% of patients; risk factors included a minimally invasive approach and maximum drainage volume.
• Patients with high drainage volume (≥300 ml/day) and triglyceride-rich but non-milky drainage faced longer hospital stays (19 days) compared to those with smaller volumes (14 days).

Surgeons should consider triglyceride-rich drainage as clinically relevant, regardless of appearance, for better patient management.