Iñaki Guasque-Gil, Servicio de Cirugía Hepatopancreatobiliar, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Daniel Aznar-Guerra, Servicio de Cirugía Hepatopancreatobiliar, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Nicole Elbjorn-Medina, Servicio de Cirugía Hepatopancreatobiliar, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Stuart J. Mialma-Omaña, Servicio de Cirugía Hepatopancreatobiliar, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Luis C. Chan-Núñez, Servicio de Cirugía Hepatopancreatobiliar, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
This review synthesizes the findings of the four studies derived from the Recurrence After Whipple’s (RAW) project, which examine postoperative complications, patient-related factors, surgical technique, and access to adjuvant therapy after pancreatoduodenectomy. Published evidence from 2023 to 2025 was integrated into a conceptual framework aimed at identifying the key determinants of oncologic success. The studies show that grade C postoperative pancreatic fistula and post-pancreatectomy hemorrhage are the complications with the greatest impact on morbidity and mortality, whereas delayed gastric emptying has limited clinical relevance. Diabetes mellitus did not influence recurrence, survival, or the benefit of adjuvant therapy, in contrast to independent prognostic predictors such as positive margins, metastatic lymph nodes, tumor size greater than 3 cm, and elevated CA19-9 levels. Venous resection was shown to be safe and oncologically equivalent when performed in experienced centers. Major complications significantly decreased the likelihood of receiving adjuvant treatment, thereby worsening survival. Overall, the RAW project reframes clinical priorities in pancreatoduodenectomy, highlighting the prevention of critical complications, preservation of the therapeutic window for adjuvancy, and decision-making driven by tumor biology.
Keywords: ncreaticoduodenectomy. Postoperative complications. Pancreatic fistula. Adjuvant therapy. Venous surgical procedures. Diabetes mellitus.