Current status and perspectives of the future of pancreatic surgery: Establishment of evidence by integration of art and science

Pancreatic cancer surgery continues to be associated with a high operative morbidity rate, poor long-term survival outcomes, and various challenges in obtaining high-level evidence. Not only is the early postoperative morbidity rate high, but also late morbidity involves lifelong nutritional support for long-term survivors. Due to poor survival outcomes even after curative surgery, pancreatic surgeons have doubts about the role of surgery as the definitive treatment for pancreatic cancer. Additionally, conducting clinical trials to obtain high-level evidence in the field of pancreatic surgery is difficult, and the results have only had a moderate impact on clinical practice due to skepticism regarding their quality. Therefore, quality evidence regarding the extent of resection, mode of approach to dissection, reconstruction methods for pancreatico-enteric anastomosis, determination of resectability, timing of surgery, and the definition of the resection margin is lacking. However, numerous innovative pancreatic surgical procedures have been developed, which may aptly have been called art when they were first introduced, regardless of whether they subsequently were supported by scientific evidence. In this review, we provide recent examples of the integration of art and science in the field of pancreatic surgery, which illustrate how the creative ideas of pancreatic surgeons evolved into generally accepted clinical practice. Pancreatic surgeons should be considered surgical artists, surgical scientists, and surgical practitioners. We look forward to more surgical artists educating future surgical artists and scientists to create a richer spirit of innovation, leading to a more beautiful integration of art and science in the field of pancreatic surgery.

Automated summary

Pancreatic cancer surgery is challenging due to high operative morbidity rate, unsatisfactory survival outcomes, and difficulties in obtaining high-level evidence. Surgical doubts arise as even after curative surgery, survival outcomes are poor. Conducting clinical trials in pancreatic surgery field is difficult and skepticism about their quality impacts their impact on clinical practice.