Our findings indicate that the two treatment strategies are equivalent. No difference in oncologic outcome was found at a median follow-up of 36 months. The significantly lower stoma rate noted in the SBTS group argues in favour of the SBTS procedure when performed in expert hands.

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Considering all pancreatic resections, a liberal fluid balance is associated with an increased rate of postoperative morbidity. However, in the case of PD with a soft pancreas, an NZF balance could lead to pancreatic stump ischemia and anastomotic failure. Intraoperative fluid management should be managed according to patient's pancreas-specific risk factors.

Among major pancreatic resections, distal pancreatectomy (DP) has always been associated with a less severe postoperative burden and a lower mortality rate compared to pancreaticoduodenectomy (PD). 1,2 Postoperative pancreatic fistula (POPF) remains the main driver of surgical morbidity, ranging from 10% to 40%. 3 For pancreatic head resections, POPF can lead to bleeding, abscess, delayed gastric emptying, and sepsis. Several surgical series have focused on possible predictors of POPF, such as body mass index (BMI), a soft pancreatic parenchyma, transection technique, and blood

This study represents the first clinical application of the only available definition of POAP as a specific complication of pancreatic surgery. POAP is associated with an increased occurrence of POPF and overall morbidity and could potentially be avoided through a specific intraoperative fluid regimen in high-risk pancreas.