Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment.

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.

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