Background: Minimally invasive surgery is increasingly preferred for left-sided pancreatic resections. The SIMPLR study aims to compare open, laparoscopic, and robotic approaches using propensity score matching analysis. Methods: This study included 258 patients with tumors of the left side of the pancreas who underwent surgery between 2016 and 2020 at three high-volume centers. The patients were divided into three groups based on their surgical approach and matched in a 1:1 ratio. Results: The open group had significantly higher estimated blood loss (620 mL vs. 320 mL, p < 0.001), longer operative time (273 vs. 216 min, p = 0.003), and longer hospital stays (16.9 vs. 6.81 days, p < 0.001) compared to the laparoscopic group. There was no difference in lymph node yield or resection status. When comparing open and robotic groups, the robotic procedures yielded a higher number of lymph nodes (24.9 vs. 15.2, p = 0.011) without being significantly longer. The laparoscopic group had a shorter operative time (210 vs. 340 min, p < 0.001), shorter ICU stays (0.63 vs. 1.64 days, p < 0.001), and shorter hospital stays (6.61 vs. 11.8 days, p < 0.001) when compared to the robotic group. There was no difference in morbidity or mortality between the three techniques. Conclusion: The laparoscopic approach exhibits short-term benefits. The three techniques are equivalent in terms of oncological safety, morbidity, and mortality.

Objective: Analysis of 6-segmentectomies coded H145678 or H123458 in the New World classification of liver resections using contemporary indicators to improve the shared surgical decision-making. Summary of background data: Specific reports on H145678 and H123458 have lacked granularity or have focused on perihilar cancer. Methods: We performed a retrospective single-center analysis of consecutive patients who underwent H145678 or H123458 from 1993 to 2024. Surgical futility (90 d mortality), failure-to-rescue, oncological futility (early tumor recurrence), and outcome futility (surgical or oncologic futility) were evaluated. Textbook outcome achievement and the potential role of liver transplantation (LT) were also assessed. Results: The study population included 237 patients with perihilar cholangiocarcinoma (n=117, 49.4%), intrahepatic cholangiocarcinoma (n=39, 16.4%), hepatocellular carcinoma (n=17, 7.2%), colorectal cancer liver metastases (n=38, 16.0%), or miscellaneous tumors (n=26, 11%). H145678 and H123458 were performed in 166 (70.0%) and 71 (30.0%) patients, respectively. Combined vascular and bile duct reconstructions were performed in 46.4% (n=110) and 62.4% (n=148) of patients, respectively. Rates of surgical, failure-to-rescue, oncological, and outcome futility were 15.6% (n=37), 30.3% (n=37), 14.5% (n=29), and 27.8% (n=66), respectively. Textbook outcome was achieved in 30.8% (n=73). With a median follow-up of 26 months, 5-year overall-survival rates and disease-free survival rates were 30.8% and 18.9%. LT criteria were not met in 94.9% (n=225). Conclusions: H123458 and H145678 offer selected patients a chance for long-term survival. LT is not a therapeutic option for most patients, and targeted rescue strategies may improve failure-to-rescue rates.