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Level 1 Versus Experiential Evidence for Mitigating Pancreatic Fistula Following Pancreatoduodenectomy: Establishing a Foundation for Future Progress
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DOI：10.1016/j.surg.2026.110395.png)
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Abstract
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Clinically relevant postoperative pancreatic fistula (CR-POPF) remains the dominant problem following pancreatoduodenectomy. Level 1 evidence, accrued over 35 years, now includes dozens of randomized controlled trials (RCTs) and meta-analyses which assess myriad mitigation techniques. Their conclusions are not generally reflected in actual adoption into clinical practice; meanwhile, experiential data might enable more comprehensive evaluation of mitigation. A conundrum arises: how can surgeons reconcile these contrasting sources to effect best practice?
Keywords:
Pancreatoduodenectomy
Postoperative Pancreatic Fistula
Level 1 Evidence
Drain
Stent
Octreotide
Pancreatogastrostomy
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