Declan

Pancreatic surgeon and prehabilitation fanatic.

[Declan @Declanfj]

Liverpools Robotic HPB Anastamosis course is back, perfect for making the jump to the reconstruction.
25/4/2026
Contact : [email protected]
@YouppiePancreas @Augishealth @IHPBA @EAHPBA @IntuitiveSurg @Jawad004

[Declan @Declanfj]

@hpbsurgeon1 @IHPBA This is an excellent point…. To expand what are the standards that we should be achieving, what numbers are needed to reach those, both centre and surgeon, what is the volume of cases to support a RPD practice assuming not all cases suitable?

[Monish Karunakaran @Mon_ish_K]

NACT in resectable pancreatic cancer

CISPD-1 phase 3 RCT

Sequential neoadjuvant Gem/ nab→ mFOLFIRINOX vs upfront Sx improved

👉EFS (15.3 vs 10.9 mo; HR 0.71, p= 0.0136)

👉OS (35.4 vs 27.2 mo; HR 0.73, p= 0.0477)

https://t.co/dXg4aR0mRh

[Shailesh V. Shrikhande @Shrikhande_SV]

The first definitive evidence wherein we might shift the approach to NAT in resectable PDAC? @JorgKleeff

[Declan @Declanfj]

@SyedAAhmad5 @Cancer_Cell Finally!!!! Some evidence supporting neoadjuvant in resectable pdac.

[Giovanni Marchegiani @Gio_Marchegiani]

Recurrence after resection of node negative p-net 🦓 How to predict?!

🇺🇸 770 pts 🍒 all node - recurrence 10%

🔮 Recurrence predicted by male sex, size > 3cm, lymphovascular invasion, grading

🤌 The debate about lymphadenectomy in p-net continues!

https://t.co/T5jQN3Qdp9

[Annals of Surgery @AnnalsofSurgery]

In IPMN-derived pancreatic ductal adenocarcinoma, a minimum of 10 lymph nodes should be harvested, and the optimal number to maximize survival is 20 lymph nodes. https://t.co/9oNn2BBmtT

[Declan @Declanfj]

@TheNotoriousHPB Completely agree, teleporting in a delayed PPH is horrendous, unlikely to see bleeding or establish any control.

IR first and quickly.

[Declan @Declanfj]

@rajibaji1983 @Gio_Marchegiani @JAMASurgery @MarcBesselink @SyedAAhmad5 @TheNotoriousHPB @ZhiVenFongMD @HalletJulie @Some4SurgeryIT1 @T4UGIS @juliomayol @villesallinen 🤢

[Declan @Declanfj]

@rajibaji1983 @TheNotoriousHPB Until AI takes over, and skynet in control.

[Declan @Declanfj]

@TheNotoriousHPB @ZhiVenFongMD @HalletJulie @MarcBesselink @DrJashDatta @SyedAAhmad5 @NEJM Until AI predicts and intervenes! thankfully this will hopefully be well beyond my retirement.

[Declan @Declanfj]

@TheNotoriousHPB @ZhiVenFongMD @HalletJulie @MarcBesselink @DrJashDatta @SyedAAhmad5 @NEJM Not better than open yet….. if we look at technology one think we know is it’s getting better all the time.

[Declan @Declanfj]

@ZhiVenFongMD @HalletJulie @MarcBesselink @DrJashDatta @SyedAAhmad5 @NEJM Lots of discussion recently. What centre volume do you need to support RPD program safely? 60 total PD, 100? Robot driving further centralisation?

[Declan @Declanfj]

@SyedAAhmad5 @MarcBesselink @DrJashDatta @NEJM I agree it’s too high. When exploring national datasets, eg this US,UK model hospital, Dutch national. Mortality is often 5-10% mark. Differences between high and low volumes exist in all data sets. Should there be minimum volumes? Centre/surgeon.

[Lee M. Ocuin MD, FACS @TheNotoriousHPB]

@MarcBesselink @DrJashDatta @SyedAAhmad5 @NEJM There’s difference between high-volume center and high-performing center. Poor performing high volume centers exist. Opposite also true. We can debate in good faith. What we can’t debate is that we can’t execute trials in the US anywhere nearly as well as @MarcBesselink and team.

[Declan @Declanfj]

@MarcBesselink @NEJMEvidence @e_mips @DPCG_official @EAHPBA @IHPBA Congratulations!!!!

[Marc Besselink @MarcBesselink]

Is minimally invasive (robot) #Whipple surgery just as safe as open surgery?

Today: #DIPLOMA2 RCT in @NEJMEvidence
➡️ https://t.co/hxoIzVHpfB

288 patients, 14 expert centers, 6 countries 🇳🇱🇮🇹🇩🇪🇧🇪🇪🇸🇸🇪): MIS equally safe as open in experienced centers. With faster recovery, fewer wound complications, less pancreatic fistula, and a shorter hospital stay.

@nine_degraaf @AnoukEmmen @Abuhilal9Abu @e_mips @EAHPBA

[Declan @Declanfj]

@rajibaji1983 @Gio_Marchegiani @TheLancet @hpb_trials @EvidenceMap @HpbLounge @AISP_Pancreas @PCE_Association @SyedAAhmad5 @HalletJulie @TheNotoriousHPB @lustgartenfdn As do we, it’s our interpretation of current evidence and best standard of care. Though in some cases I do wonder if upfront chemo might be better…..it’s just picking the right ones.

[deniz balci @dbalci]

A new Nature paper just delivered a shock to a long-lived oncology myth.
🔗 https://t.co/gVGM9QvQqw

For years we’ve been told that radiotherapy—and its cousins like SBRT, TARE, Y-90—might trigger the “abscopal effect,” a systemic immune response that helps control distant disease.

This study shows the opposite: radiation induces Amphiregulin (AREG) and can stimulate distant metastasis through myeloid-cell reprogramming.

So what does this mean for HPB oncology?

👉 The “abscopal effect” is not a clinical strategy. It’s a story.
👉 Radiation-driven systemic benefit is, at best, unreliable—and at worst, misleading.
👉 Surgery remains the only method of local control with reproducible impact on survival.