This systematic review provides a comprehensive synthesis

The gap

Evidence profile

Stated in the future work and limitations sections of the source papers, classified as general, spanning 3 journals.

Supporting evidence — 3 representative gaps

• Psychological intervention and health education effects on quality of life in patients after pancreatic cancer surgery: A meta-analysis (2026) · World Journal of Gastrointestinal Surgery · doi

  Pancreatic cancer has well-established precursor lesions, which, if identified and man- aged early on leads to surgery for pancreatic conditions with potentially better oncological prognosis. The increased use of cross-sectional imaging means more patients may be diag- nosed with early lesions such as IPMNs that have adverse radiological features but are not Cancers 2025, 17, 2602 18 of 20 yet invasive cancer. Similarly NETs although relatively rare, may be detected earlier when they are small neoplasms. For this group of patients with better prognosis lesions, quality of life after pancreatic surgery will become an increasingly important issue. Likewise, im- provements in perioperative outcomes such as declining early mortality, means that there are more patients for whom quality of survivorship rather than mere survivorship matters. Increasing use of neoadjuvant approaches to PDAC may change the profile of patients having surgery for invasive cancer in two ways: (1) Downstaging tumours pre-operatively may allow more patients to have surgery with curative intent and mean that more patients complete systemic treatment as well as surgery, which leads to longer survival. (2) Patients with aggressive lesions may progress while undergoing neoadjuvant treatment and this group may be spared high impact surgery that would have been futile, although the final outcome is palliative. PDAC is associated with poor prognosis, which is often attributed to the multifactorial nature by which it evolves. It is difficult to treat successfully with systemic therapy as it often develops resistance to treatments due to frequent mutations and demonstrates genetic heterogeneity within the same primary tumour. Treatments that have been successful in targeting single genes in other types of cancer such as EGFR in lung cancer or B-RAF in melanoma, are not effective in pancreatic cancer for this reason [40]. Standardised measures of quality of life after pancreatic surgery such as EORTC QLQ Pan 26 [3] and PEI Q [23]. The PEI Q can be used to identify areas of care that warrant further research. Improvements in type 3c Diabetes management and its monitoring can potentially improve quality of life in this patient group, potentially making total pancreatectomy, where indicated, a feasible option for more patients. Early involvement of diabetic specialist teams for patients who have undergone pancreatic resection is also important. Increased recognition of the importance of PERT can lead to better outcomes where this has been neglected historically. Involvement of multidisciplinary teams including dieticians and credentialled clinical nurse specialists may reap benefits. Involvement of palliative care physicians to assist with symptom control where appropriate is likely to be advantageous. There is a role for early referral of patients to supportive or palliative care due to the high burden of symptoms and poor prognosis. Interventions such as coeliac plexus neurolysis should be considered early when appropriate. The impact of delayed gastric emptying and other digestive disturbances after pancreaticoduodenectomy has tended to be under-recognised and resolving this issue remains a challenge. Further research into this problem, its solutions and its impact may be important for improving quality of life for pancreatectomy survivors.

  generalstated in future workevidence 5/5
  Keywords: patients surgery pancreatic cancer early quality lesions prognosis life potentially better group important impact palliative
• Effectiveness of multidisciplinary team collaboration in focal pancreatic lesion management: a systematic review (2026) · Abdominal Radiology · doi

  This systematic review provides a comprehensive synthesis of the specific impact of the MDT approach for focal pancre- atic lesions, moving beyond survival to examine effects on diagnostics, treatment, compliance, and patient outcomes. However, our findings must be interpreted in light of several important limitations. The retrospective design and selection bias across studies limited the evidence qual- ity [51]. Furthermore, while the included studies were predominantly focused on PDAC, with only a minority specifically examining PCNs, the primary studies did not employ a uniform patient population or report outcomes in a manner that permitted formal subgroup analyses by lesion category. Given the substantial biological and clini- cal differences between PDAC and PCNs, this represents an important limitation of this review. Substantial heterogene- ity existed both in patient populations, ranging from exclu- sively PDAC cohorts to mixed or solely PCN cohorts, and in the MDT interventions evaluated (from case-based tumor boards to patient-facing clinics). This variation, together with the absence of standardized metrics for assessing MDT process quality, precluded a formal meta-analysis and complicated the attribution of observed effects to specific MDT components. Additionally, none of the pre–post study designs controlled for temporal improvements in imaging modalities or systemic therapies, which may have inflated the apparent benefit of MDT care. Finally, despite a broad search strategy, varied nomenclature for MDTs and poten- tial publication bias means some relevant studies may have been missed.

  generalstated in limitationsevidence 5/5
  Keywords: patient pdac review specific effects outcomes important bias pcns formal substantial cohorts systematic provides comprehensive
• O tamanho por si só não basta: Ki-67 e padrões de invasão identificam tumores neuroendócrinos pancreáticos de alto risco (2026) · ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) · doi

  This study presents the largest series of neuroendocrine tumors operated on at a single Brazilian center, including epidemiological data, survival, and prognostic factors. Pancreatic surgery remains a procedure with high morbidity, and minimally invasive approaches are gaining more ground. Patients treated surgically showed a high 5-year overall survival rate of 92.1%. The identification of poor prognostic factors plays an important role in oncological follow-up and in better selecting patients for the "Active Surveillance" (AS) strategy and non-standardized surgeries. Important prognostic factors were correlated, such as tumor size greater than 2.0 cm, Ki-67 index, and lymphovascular invasion. In a subgroup analysis of patients with tumors measuring 2.1- 2.5 cm, we found a recurrence and lymph node disease profile comparable to patients eligible for active surveillance. _______________________________________________________________ HIGHLIGHTS Pancreatic neuroendocrine tumors (pNETS) constitute a heterogeneous and rare disease worldwide. SciELO Preprints - This document is a preprint and its current status is available at: https://doi.org/10.1590/0102-672020260000027e1956 This study presents the largest series of pNET operated on at a single Brazilian center. Size is not enough to predict behavior in pNETS. Patients with 2.1-2.5cm tumor present with a pattern of recurrence similar do less than 2.0cm patients which are candidates for active surveillance strategy. _______________________________________________________________ Authors’ contributions Conceptualization: Cortelli DASM, Coimbra FJF Investigation: Cortelli DASM Methodology: Cortelli DASM, Coimbra FJF, Farias IC Data analysis: Cortelli DASM, Coimbra FJF Writing original article: Cortelli DASM, Coimbra FJF, Farias IC, Diniz AL, Ribeiro HSC Literature review: Cortelli DASM, Torres SM, Godoy AL, Gonçalves CA _______________________________________________________________________ The information regarding the investigation, methodology and data analysis of the article is archived under the responsibility of the authors. Editor: Nelson Adami Andreollo _____________________________________________________________________ INTRODUCTION Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous disease, which can exhibit either an indolent or an overtly malignant behavior. The primary treatment for pNETs is surgical. Minimally invasive surgery (laparoscopic and robotic) has been SciELO Preprints - This document is a preprint and its current status is available at: https://doi.org/10.1590/0102-672020260000027e1956 increasingly performed, with superior outcomes in terms of morbidity and length of hospital stay1,12.

  generalstated in future workevidence 5/5
  Keywords: patients cortelli dasm tumors active surveillance pnets coimbra neuroendocrine prognostic factors pancreatic strategy disease presents

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