Challenging dogmas in pancreatic surgery: biliary drainage, outcome and beyond

In this thesis we have presented the results of 5 years of basic and clinical research on pancreatic surgery. Traditions have been evaluated, controversies have been settled, physician-centered and patient-centered outcomes were evaluated, and many suggestions for clinical practice and future research were provided. Pancreatic and periampullary cancer are relatively rare disease entities with dismal prognoses. Eligibility to treat the disease surgically is limited to a minority of patients, and even then cure is exceptional. In the near future much is expected from novel molecular markers and whole genome sequencing, which might elucidate the oncogenic context and expose potential therapeutic vulnerabilities. Considering the rarity of pancreatic disorders these initiatives are preferably executed in close c Finally, the process of surgical innovation is as old as the surgical practice itself, but evaluation within a standardized framework has only just begun. Conscientious and critical application of the IDEAL framework is the key to improve surgical care such that interventions will become safer and better.