Original Investigation

Activity and Physiological Stress Within 90 Days After Minimally Invasive and Open Pancreatoduodenectomy

JAMA Surgery 10.1001/jamasurg.2026.1503

May 20, 2026 at 11:00 AM EDT

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What are the differences in postoperative recovery after discharge—using activity tracking—of minimally invasive pancreatoduodenectomy (MIPD) vs open pancreatoduodenectomy (OPD) in patients with upfront resectable neoplasm in the pancreatic head or periampullary region?In the international DIPLOMA-2 randomized clinical trial including 288 patients, MIPD resulted in modestly higher postoperative activity levels and less physiological stress during the entire 90-day postoperative period, compared with OPD.These findings suggest sustained recovery benefits after MIPD, although their clinical significance and generalizability remain uncertain.

Corresponding Authors: Mohammed Abu Hilal, MD, PhD, Department of Surgery, School of Medicine, University of Jordan, Amman 11942, Jordan (abuhilal9@gmail.com); Marc G. Besselink, MD, PhD, Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands (m.g.besselink@amsterdamUMC.nl).

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