Aim: Risk prediction models for mortality, severe postoperative complications, and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy were established using data from the National Clinical Database more than a decade ago, and the surgical outcomes of pancreaticoduodenectomy have improved over the years. The aim of this study is to update the risk prediction model for pancreaticoduodenectomy using National Clinical Database data.Methods: Between 2019 and 2021, the data of 35 365 patients who underwent pancreaticoduodenectomy and who were registered in the National Clinical Database were retrospectively analyzed. According to the registration year, the patients were divided into two cohorts: the development cohort (2019–2020; n = 23 654) and the validation cohort (2021; n = 11 711). Logistic regression analyses were performed to create risk models for surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula.Results: Overall, the rates of surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula were 1.8%, 2.2%, and 1.3%, respectively. Logistic regression analyses revealed 28, 28, and 14 risk factors for surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula, respectively. The area under the receiver operating characteristic curve of the risk model in the development cohort was 0.759 for surgical mortality, 0.712 for severe complications, and 0.699 for postoperative pancreatic fistula, comparable to the validation cohort. The calibration plots were favorable in both cohorts.Conclusion: The updated risk model for pancreaticoduodenectomy will be useful to predict surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula.

Surgical resection is the only curative treatment for perihilar cholangiocarcinoma (pCCA); however, the majority of patients experience postoperative recur

INTRODUCTION: Although several studies have highlighted the importance of recognizing gastroduodenal artery (GDA) anomalies during pancreaticoduodenectomy, their relevance during distal pancreatectomy has not been explored. Herein, we describe the safe performance of laparoscopic distal pancreatectomy in a patient with a rare vascular anomaly, specifically a GDA originating from the superior mesenteric artery (SMA).CASE PRESENTATION: A 63-year-old woman presented with recurrent pancreatitis due to a cystic lesion in the pancreatic body. Imaging suggested a branch-duct intraductal papillary mucinous neoplasm with substantial ductal stenosis. Multidetector CT (MDCT) revealed a rare anatomical variant: the GDA, arising from the SMA and traversing along the inferior border of the pancreas. Laparoscopic distal pancreatectomy was performed after placing an endoscopic nasopancreatic drainage tube. The aberrant GDA was successfully preserved through careful dissection and vessel loop isolation. Pancreatic transection was completed without vascular injury. A postoperative pancreatic fistula developed and was conservatively managed. Histopathological examination confirmed that the lesion was an intraductal papillary mucinous carcinoma without any invasive features. Follow-up MDCT revealed sustained patency and perfusion of the preserved GDA, right gastroepiploic artery, and anterior superior pancreaticoduodenal artery.CONCLUSIONS: Laparoscopic pancreatectomy can be safely performed in patients with SMA-derived GDA anomalies, when supported by detailed preoperative imaging and precise intraoperative techniques. These findings highlight the necessity of routine preoperative vascular assessment in patients undergoing minimally invasive pancreatic surgery, reinforcing the broader applicability of these approaches for patients with complicated vascular anatomy.

Purpose: This study aimed to determine the risk factors for new-onset hepatic steatosis after total pancreatectomy (TP), focusing on muscle loss and sex. Methods: We retrospectively analyzed 100 patients who underwent TP between 2005 and 2024. Nutritional parameters, BMI, muscle volume, and liver status were evaluated. Logistic regression and subgroup analyses were performed to identify the risk factors for hepatic steatosis. Results: The prevalence of hepatic steatosis increased from 3.0% preoperatively to 24.0% at 3–6 months after TP. Female patients showed a significantly higher incidence of hepatic steatosis than male patients (37.8% vs. 12.7%, respectively). A multivariate analysis identified female sex (odds ratio: 7.77, 95% confidence interval: 2.03–29.8, p = 0.009), younger age (0.93, 0.88–0.98, 0.011), and higher preoperative BMI (1.28, 1.05–1.63, 0.015) as independent risk factors. Among the female patients, a younger age, one-stage TP, greater reductions in SMI, portal vein resection, longer operative time, greater blood loss, and diarrhea at discharge were associated with new-onset hepatic steatosis. However, a lower intraoperative blood loss potentially contributes to recovery from hepatic steatosis after TP. Conclusions: A female sex is a high risk factor for hepatic steatosis after TP. Reducing operative stress and preserving muscle volume may facilitate the prevention and recovery from hepatic steatosis.