{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:50:36Z","timestamp":1791442236401,"version":"4.3.3"},"reference-count":64,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frailty is an important determinant of postoperative outcomes after pancreatic surgery. However, available assessment instruments are heterogeneous and may inadequately capture the interaction between patient vulnerability, nutritional status, body composition, and procedure\u2010specific risk. This systematic review evaluated frailty assessment tools in pancreatic surgery and proposed a conceptual pancreas\u2010specific framework for surgical vulnerability assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted according to PRISMA 2020 guidelines. PubMed\/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched for studies published between January 2016 and April 2026 evaluating frailty in adult patients undergoing pancreatic resection. Findings were primarily synthesized narratively because of substantial methodological heterogeneity. An exploratory subgroup meta\u2010analysis was restricted to studies using the Modified Frailty Index that reported adjusted effect estimates for major morbidity or short\u2010term mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty studies involving more than 150,000 patients were included. The Modified Frailty Index was the most frequently used instrument, followed by the Hospital Frailty Risk Score. Frailty was generally associated with increased postoperative morbidity, major complications, mortality, prolonged hospitalization, non\u2010home discharge, and functional decline, although the extent of confounding control varied across studies. Several associations persisted in adjusted analyses, whereas other findings were supported only by unadjusted comparisons. In an exploratory subgroup meta\u2010analysis restricted to adjusted estimates from Modified Frailty Index studies, greater mFI\u2010defined frailty burden was associated with major morbidity (pooled OR 1.60, 95% CI 1.27\u20132.01;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a053%) and short\u2010term mortality (pooled OR 1.31, 95% CI 1.16\u20131.48;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%), although these findings remain hypothesis\u2010generating because of substantial methodological heterogeneity. However, most tools primarily reflect comorbidity burden and incompletely capture nutritional status, sarcopenia, obesity, and pancreas\u2010specific operative risk. Current evidence suggests that surgical vulnerability in pancreatic resection results from the interaction between patient\u2010related, nutritional\u2010, body\u2010composition, and procedure\u2010related factors rather than frailty alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Frailty is clinically relevant to postoperative risk assessment in pancreatic surgery and should be incorporated into preoperative evaluation. Existing tools, however, inadequately capture the multidimensional nature of surgical vulnerability. We therefore propose the PANFRAIL framework, a conceptual, hypothesis\u2010generating model integrating frailty, nutritional status, body composition, procedure\u2010related complexity, and pancreas\u2010specific risk to guide future development of pancreatic surgery\u2010specific risk assessment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70595","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:07:48Z","timestamp":1791439668000},"source":"Crossref","is-referenced-by-count":0,"title":["Beyond Frailty in Pancreatic Surgery: Toward a Pancreas\u2010Specific Surgical Vulnerability Framework"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-7409","authenticated-orcid":false,"given":"Tiziana","family":"Marchese","sequence":"first","affiliation":[{"name":"General and HPB Surgery Department Vito Fazzi Hospital  Lecce Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8211-7370","authenticated-orcid":false,"given":"Valentina","family":"Valle","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive General &amp; Robotic Surgery University of Illinois at Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Comandatore","sequence":"additional","affiliation":[{"name":"General Surgery Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio","family":"Di Franco","sequence":"additional","affiliation":[{"name":"General Surgery Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello G.","family":"Spampinato","sequence":"additional","affiliation":[{"name":"General and HPB Surgery Department Vito Fazzi Hospital  Lecce Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3129-3208","authenticated-orcid":false,"given":"Benedetto","family":"Ielpo","sequence":"additional","affiliation":[{"name":"HPB Unit Hospital del Mar Pompeu Fabra University  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7742-9556","authenticated-orcid":false,"given":"Luca","family":"Morelli","sequence":"additional","affiliation":[{"name":"General Surgery Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PANFRAIL Collaborative Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000217673.04165.ea"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200208000\u201000001"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199905000\u201000012"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.12.1310"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9468"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v22.i28.6456"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/8052175"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2026.110153"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477\u20102574.2012.00549.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.01.028"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.m146"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(12)62167\u20109"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2015.08.428"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.01.021"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2017.11.005"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)30668\u20108"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050051"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1519\/00139143\u2010200831010\u201000002"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/49.2.m85"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afl041"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/rej.2007.0569"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010014\u20100579\u20100"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"issue":"3","key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 Update of the International Study Group (ISGPS) Definition and Grading of Postoperative Pancreatic Fistula: 11 Years After","volume":"161","author":"Bassi C.","year":"2017","journal-title":"Surgery"},{"key":"e_1_2_10_26_2","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1016\/j.surg.2016.11.014.","DOI":"10.1016\/j.surg.2016.11.014"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.02.001"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.05.005"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000518267"},{"key":"e_1_2_10_30_1","volume-title":"The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G. 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