Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment.
I, G.G., D, A.G., N, E.M., SJ, M.O., & LC, C.N. (2026). Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment.. Cirugia y cirujanos. https://doi.org/10.24875/CIRU.25000559
I GG, D AG, N EM, SJ MO, LC CN. Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment.. Cirugia y cirujanos. 2026; doi: 10.24875/CIRU.25000559
I GG, D AG, N EM, et al. Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment.[J]. Cirugia y cirujanos. 2026. DOI: 10.24875/CIRU.25000559.
@article{i2026,
author = {Guasque-Gil I and Aznar-Guerra D and Elbjorn-Medina N and Mialma-Omaña SJ and Chan-Núñez LC},
title = {Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment.},
journal = {Cirugia y cirujanos},
year = {2026},
doi = {10.24875/CIRU.25000559},
note = {PMID: 42641177},
}
TY - JOUR AU - Guasque-Gil I AU - Aznar-Guerra D AU - Elbjorn-Medina N AU - Mialma-Omaña SJ AU - Chan-Núñez LC TI - Findings from the RAW Study: a narrative review of postoperative complications, patient factors, venous resection, and adjuvant treatment. T2 - Cirugia y cirujanos PY - 2026 DO - 10.24875/CIRU.25000559 AN - PMID:42641177 ER -
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. Este trabajo sintetiza y analiza los hallazgos de los cuatro estudios derivados del proyecto Recurrence After Whipple’s (RAW), enfocados en complicaciones postoperatorias, factores del paciente, técnica quirúrgica y acceso a terapia adyuvante después de pancreatoduodenectomía. La revisión integró la evidencia publicada entre 2023 y 2025 dentro de un marco conceptual orientado a identificar los determinantes del éxito oncológico. Los estudios muestran que la fístula pancreática postoperatoria de grado C y la hemorragia pospancreatectomía representan las complicaciones de mayor impacto en morbilidad y mortalidad, mientras que el retraso en el vaciamiento gástrico tiene una relevancia clínica limitada. La diabetes mellitus no modificó la recurrencia, la supervivencia ni el beneficio de la adyuvancia, en contraste con predictores adversos como márgenes positivos, ganglios metastásicos, tumores mayores de 3 cm y niveles elevados de CA19-9. La resección venosa demostró ser segura y oncológicamente equivalente cuando es realizada en centros con experiencia. Asimismo, las complicaciones mayores reducen la probabilidad de recibir tratamiento adyuvante, comprometiendo la supervivencia. En conjunto, RAW redefine las prioridades clínicas en pancreatoduodenectomía, enfatizando la prevención de complicaciones críticas, la conservación de la ventana terapéutica para adyuvancia y la toma de decisiones guiada por la biología tumoral.