{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:54:10Z","timestamp":1791564850660,"version":"4.3.4"},"reference-count":37,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","surgjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Surgery"],"published-print":{"date-parts":[[2026,12]]},"DOI":"10.1016\/j.surg.2026.110580","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:56:05Z","timestamp":1788155765000},"page":"110580","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Transection level matters: A prospective study on pancreatic fistula risk after left pancreatectomy"],"prefix":"10.1016","volume":"200","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5473-5897","authenticated-orcid":false,"given":"Angelica","family":"Nepi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5244-4357","authenticated-orcid":false,"given":"Matteo","family":"De Pastena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Lionetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Paiella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Ingaglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Casule","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Tondato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Malleo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Salvia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.surg.2026.110580_bib1","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1016\/S0140-6736(11)60237-7","article-title":"Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial","volume":"377","author":"Diener","year":"2011","journal-title":"Lancet"},{"key":"10.1016\/j.surg.2026.110580_bib2","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1002\/jhbp.268","article-title":"Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching","volume":"22","author":"Nakamura","year":"2015","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"10.1016\/j.surg.2026.110580_bib3","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.amjsurg.2012.11.023","article-title":"Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy","volume":"206","author":"Kawai","year":"2013","journal-title":"Am J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib4","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.pan.2013.04.322","article-title":"Pre-operative prediction of pancreatic fistula: is it possible?","volume":"13","author":"Roberts","year":"2013","journal-title":"Pancreatology"},{"key":"10.1016\/j.surg.2026.110580_bib5","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.surg.2004.06.063","article-title":"Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy","volume":"137","author":"Sledzianowski","year":"2005","journal-title":"Surgery"},{"key":"10.1016\/j.surg.2026.110580_bib6","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/j.1445-2197.2010.05337.x","article-title":"Pancreatic fistula after distal pancreatectomy: incidence, risk factors and management","volume":"80","author":"Kah Heng","year":"2010","journal-title":"ANZ J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/bjs.9653","article-title":"Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy","volume":"102","author":"Zhang","year":"2015","journal-title":"Br J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib8","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s11605-012-1849-y","article-title":"After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure","volume":"16","author":"Hashimoto","year":"2012","journal-title":"J Gastrointest Surg"},{"key":"10.1016\/j.surg.2026.110580_bib9","doi-asserted-by":"crossref","first-page":"e1099","DOI":"10.1097\/SLA.0000000000005497","article-title":"Distal Pancreatectomy Fistula Risk Score (D-FRS): development and international validation","volume":"277","author":"De Pastena","year":"2023","journal-title":"Ann Surg"},{"key":"10.1016\/j.surg.2026.110580_bib10","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.pan.2020.12.021","article-title":"Division of the pancreas at the neck reduces postoperative pancreatic fistula in laparoscopic distal pancreatectomy: comparison of pancreatic division at the body","volume":"21","author":"Sugimoto","year":"2021","journal-title":"Pancreatology"},{"key":"10.1016\/j.surg.2026.110580_bib11","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ijsu.2019.03.020","article-title":"Level of pancreatic division and postoperative pancreatic fistula after distal pancreatectomy: a retrospective case-control study of 157 patients with non-pancreatic ductal adenocarcinoma lesions","volume":"65","author":"Nakamura","year":"2019","journal-title":"Int J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ijsu.2020.08.001","article-title":"Neck transection level and postoperative pancreatic fistula after pancreaticoduodenectomy: a retrospective cohort study of 195 patients","volume":"82","author":"Bardol","year":"2020","journal-title":"Int J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib13","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s00534-009-0248-6","article-title":"Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage","volume":"17","author":"Bassi","year":"2010","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"10.1016\/j.surg.2026.110580_bib14","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.3390\/cancers17172741","article-title":"A review of post-operative pancreatic fistula following distal pancreatectomy: risk factors, consequences, and mitigation strategies","volume":"17","author":"Alvikas","year":"2025","journal-title":"Cancers (Basel)"},{"key":"10.1016\/j.surg.2026.110580_bib15","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1007\/s11605-020-04824-y","article-title":"Spleen-preserving distal pancreatectomy with vein scarifying and artery saving as an alternative for warshaw method","volume":"25","author":"Kim","year":"2021","journal-title":"J Gastrointest Surg"},{"key":"10.1016\/j.surg.2026.110580_bib16","article-title":"Robotic spleen-preserving distal pancreatectomy: the Warshaw and Kimura techniques","volume":"26(209)","author":"Kotsifa","year":"2024","journal-title":"J Vis Exp"},{"key":"10.1016\/j.surg.2026.110580_bib17","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1001\/archsurg.1988.01400290032004","article-title":"Conservation of the spleen with distal pancreatectomy","volume":"123","author":"Warshaw","year":"1988","journal-title":"Arch Surg"},{"key":"10.1016\/j.surg.2026.110580_bib18","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S2468-1253(24)00037-2","article-title":"Prophylactic abdominal drainage after distal pancreatectomy (PANDORINA): an international, multicentre, open-label, randomised controlled, non-inferiority trial","volume":"9","author":"van Bodegraven","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"10.1016\/j.surg.2026.110580_bib19","doi-asserted-by":"crossref","DOI":"10.1093\/bjs\/znae039","article-title":"Standardizing definitions and terminology of left-sided pancreatic resections through an international Delphi consensus","volume":"111","author":"van Ramshorst","year":"2024","journal-title":"Br J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib20","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","year":"2017","journal-title":"Surgery"},{"key":"10.1016\/j.surg.2026.110580_bib21","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1086\/501620","article-title":"Guideline for prevention of surgical site infection, 1999","volume":"20","author":"Mangram","year":"1999","journal-title":"Infect Control Hosp Epidemiol"},{"key":"10.1016\/j.surg.2026.110580_bib22","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.surg.2007.02.001","article-title":"Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"10.1016\/j.surg.2026.110580_bib23","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.surg.2007.05.005","article-title":"Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"10.1016\/j.surg.2026.110580_bib24","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"10.1016\/j.surg.2026.110580_bib25","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1159\/000328785","article-title":"Pancreatogenic diabetes after pancreatic resection","volume":"11","author":"Maeda","year":"2011","journal-title":"Pancreatology"},{"issue":"Suppl 1","key":"10.1016\/j.surg.2026.110580_bib26","first-page":"S19","article-title":"Classification and diagnosis of diabetes: standards of medical care in diabetes\u20142023","volume":"46","year":"2023","journal-title":"Diabetes Care"},{"key":"10.1016\/j.surg.2026.110580_bib27","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/SLA.0000000000005226","article-title":"Postpancreatectomy Acute Pancreatitis (PPAP): definition and grading from the International Study Group for pancreatic surgery (ISGPS)","volume":"275","author":"Marchegiani","year":"2022","journal-title":"Ann Surg"},{"key":"10.1016\/j.surg.2026.110580_bib28","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg"},{"key":"10.1016\/j.surg.2026.110580_bib29","first-page":"5703","article-title":"Division of the pancreas at the neck reduces postoperative pancreatic fistula in laparoscopic distal pancreatectomy: comparison with pancreatic body transection","volume":"35","author":"Sugimoto","year":"2021","journal-title":"Surg Endosc"},{"key":"10.1016\/j.surg.2026.110580_bib30","first-page":"760","article-title":"Level of pancreatic division and postoperative pancreatic fistula after distal pancreatectomy: a retrospective case-control study","volume":"49","author":"Nakamura","year":"2019","journal-title":"Surg Today"},{"key":"10.1016\/j.surg.2026.110580_bib31","first-page":"1640","article-title":"Pancreatic neck transection level is associated with postoperative pancreatic fistula after pancreaticoduodenectomy: a retrospective cohort study","volume":"22","author":"Bardol","year":"2020","journal-title":"HPB (Oxford)"},{"key":"10.1016\/j.surg.2026.110580_bib32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jamcollsurg.2012.09.002","article-title":"A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy","volume":"216","author":"Callery","year":"2013","journal-title":"J Am Coll Surg"},{"key":"10.1016\/j.surg.2026.110580_bib33","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/SLA.0000000000001537","article-title":"Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation","volume":"264","author":"McMillan","year":"2016","journal-title":"Ann Surg"},{"key":"10.1016\/j.surg.2026.110580_bib34","doi-asserted-by":"crossref","first-page":"4991","DOI":"10.1007\/s00464-019-07293-w","article-title":"Peritoneal drainage or no drainage after pancreaticoduodenectomy and\/or distal pancreatectomy: a meta-analysis and systematic review","volume":"34","author":"Lyu","year":"2020","journal-title":"Surg Endosc"},{"key":"10.1016\/j.surg.2026.110580_bib35","doi-asserted-by":"crossref","DOI":"10.1155\/2009\/404520","article-title":"Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes","volume":"2009","author":"Schmidt","year":"2009","journal-title":"HPB Surg"},{"key":"10.1016\/j.surg.2026.110580_bib36","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/bjs.5316","article-title":"Disturbances of the microcirculation in acute pancreatitis","volume":"93","author":"Cuthbertson","year":"2006","journal-title":"Br J Surg"},{"key":"10.1016\/j.surg.2026.110580_bib37","doi-asserted-by":"crossref","first-page":"4225","DOI":"10.1007\/s00464-025-11787-1","article-title":"Postpancreatectomy acute pancreatitis in pancreaticoduodenectomy and distal pancreatectomy: a retrospective cohort study on risk factors and clinical outcomes","volume":"39","author":"Cheng","year":"2025","journal-title":"Surg Endosc"}],"container-title":["Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0039606026005052?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0039606026005052?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:17:03Z","timestamp":1791562623000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0039606026005052"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,12]]},"references-count":37,"alternative-id":["S0039606026005052"],"URL":"https:\/\/doi.org\/10.1016\/j.surg.2026.110580","relation":{},"ISSN":["0039-6060"],"issn-type":[{"value":"0039-6060","type":"print"}],"subject":[],"published":{"date-parts":[[2026,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Transection level matters: A prospective study on pancreatic fistula risk after left pancreatectomy","name":"articletitle","label":"Article Title"},{"value":"Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.surg.2026.110580","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"110580"}}