Journal of Clinical Practice · Published 2026-06-13 · DOI 10.17816/clinpract699664
Vasiliy I. Egorov, Bulat F. Rachmatullin, Artur V. Pasheev
Over the past 15–20 years, pancreatic surgery centers worldwide have achieved fundamentally low in-hospital mortality rates of less than 1–3%. Several published data report near-zero mortality in key single-center series. These achievements allow us to rethink the concept of «zero mortality,» transforming it from a statistical abstraction into a tangible clinical goal, achieving the systematic development of modern surgical, anesthesiological, and organizational protocols. The concept of «zero mortality» in pancreaticoduodenectomy is achieved through the systematic organization of organizational, surgical, and functional protocols. The paradox of high frequency (up to 50%) with low mortality makes it less effective at preventing death after its onset (low failure-to-rescue rate, FTR). A key determinant of success is the centralization of operations in high-volume centers (20 resections/year), which ensures a predictable flow of FTRs. Standardization of surgical technique, including the selection of a reproducible anastomosis method, minimization of blood loss, and a balanced assessment of resectability, reduces the risk of serious intraoperative complications. Implementation of early outcome algorithms based on a dynamic diptych of clinical and laboratory markers, with a focus on minimally invasive treatment methods (interventional radiology), improves outcomes. Rigorous multidisciplinary patient selection and growth acceleration protocols, effective even in high-risk patients, are essential elements. Systematic audit of mortality causes allows for the identification and prevention of preventive factors. Achieving the lowest possible mortality after pancreaticoduodenectomy is a feasible clinical goal. It is based on individual skill and a centralized, standardized, and multidisciplinary care system focused on minimizing FTR through early diagnosis and aggressive treatment.
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Egorov, V., Rachmatullin, B., Pasheev, A. (2026). The concept of zero mortality in pancreaticoduodenectomy: analysis of key success factors. Journal of Clinical Practice. https://doi.org/10.17816/clinpract699664