Purpose: Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset (2014–2020) was reviewed for any POPF after OPD. Propensity score matching (PSM) compared MIPD to OPD, and then RPD to LPD. Results: Among 3,083 patients who developed a POPF, 2,843 (92.2%) underwent OPD and 240 (7.8%) MIPD; of these, 25.0% were LPD (n = 60) and 75.0% RPD (n = 180). Grade B POPF was observed in 45.4% (n = 1,400), and grade C in 6.0% (n = 185). After PSM, MIPD patients had higher rates of CR-POPF (47.3% OPD vs. 54.4% MIPD, p = 0.037), as well as higher reoperation (9.1% vs. 15.3%, p = 0.006), delayed gastric emptying (29.2% vs. 35.8%, p = 0.041), and readmission rates (28.2% vs. 35.1%, p = 0.032). However, CR-POPF rates were comparable between LPD and RPD (56.8% vs. 49.3%, p = 0.408). Conclusion The impact of POPF is more clinically pronounced after MIPD than OPD with a more complex postoperative course. The difference appears to be attributed to the minimally invasive environment itself as no difference was noted between LPD and RPD. A clear biological explanation of this clinical observation remains missing. Further studies are warranted.

Prostate cancer shows significant racial disparity, with men of African ancestry disproportionately impacted. While prostate cancer health disparity studies focus on elucidating the contributing socioeconomic, lifestyle, environmental, biological and underlying genetic factors, genome sequencing is helping to reduce the burden through disease stratification and treatment. Sub-Saharan Africa has, till now, been excluded from these benefits. The new Prostate Cancer Precision Health Africa1K Health Equity Research Outcomes and Improvement Consortium has been tasked with addressing this gap. Initiating efforts in Southern Africa, with the highest globally recorded regional mortality rates, in this review we discuss our earliest observations, with the objective to share knowledge, encourage further inclusivity across Sub-Saharan Africa, while considering challenges and benefits. Most notably, and in contrast to regions of current scientific efforts, African nations not only represent extreme disparities in rural-urban transition, but our early data also suggests that this transition has direct impact on both genetic and nongenetic health determinants, with further translation into tumour genome disparities. Ultimately, we propose from this first-of-its-kind resource, that rural communities provide an unmet opportunity to control for cultural practices, regional movement, genetic ancestry, and environmental exposures to enhance African inclusion in prostate cancer health disparity studies.

Prostate cancer shows significant racial disparity, with men of African ancestry disproportionately impacted. While prostate cancer health disparity studies focus on elucidating the contributing socioeconomic, lifestyle, environmental, biological and underlying genetic factors, genome sequencing is helping to reduce the burden through disease stratification and treatment. Sub-Saharan Africa has, till now, been excluded from these benefits. The new Prostate Cancer Precision Health Africa1K Health Equity Research Outcomes and Improvement Consortium has been tasked with addressing this gap. Initiating efforts in Southern Africa, with the highest globally recorded regional mortality rates, in this review we discuss our earliest observations, with the objective to share knowledge, encourage further inclusivity across Sub-Saharan Africa, while considering challenges and benefits. Most notably, and in contrast to regions of current scientific efforts, African nations not only represent extreme disparities in rural-urban transition, but our early data also suggests that this transition has direct impact on both genetic and nongenetic health determinants, with further translation into tumour genome disparities. Ultimately, we propose from this first-of-its-kind resource, that rural communities provide an unmet opportunity to control for cultural practices, regional movement, genetic ancestry, and environmental exposures to enhance African inclusion in prostate cancer health disparity studies.

Prostate cancer shows significant racial disparity, with men of African ancestry disproportionately impacted. While prostate cancer health disparity studies focus on elucidating the contributing socioeconomic, lifestyle, environmental, biological and underlying genetic factors, genome sequencing is helping to reduce the burden through disease stratification and treatment. Sub-Saharan Africa has, till now, been excluded from these benefits. The new Prostate Cancer Precision Health Africa1K Health Equity Research Outcomes and Improvement Consortium has been tasked with addressing this gap. Initiating efforts in Southern Africa, with the highest globally recorded regional mortality rates, in this review we discuss our earliest observations, with the objective to share knowledge, encourage further inclusivity across Sub-Saharan Africa, while considering challenges and benefits. Most notably, and in contrast to regions of current scientific efforts, African nations not only represent extreme disparities in rural-urban transition, but our early data also suggests that this transition has direct impact on both genetic and nongenetic health determinants, with further translation into tumour genome disparities. Ultimately, we propose from this first-of-its-kind resource, that rural communities provide an unmet opportunity to control for cultural practices, regional movement, genetic ancestry, and environmental exposures to enhance African inclusion in prostate cancer health disparity studies.

Prostate cancer shows significant racial disparity, with men of African ancestry disproportionately impacted. While prostate cancer health disparity studies focus on elucidating the contributing socioeconomic, lifestyle, environmental, biological and underlying genetic factors, genome sequencing is helping to reduce the burden through disease stratification and treatment. Sub-Saharan Africa has, till now, been excluded from these benefits. The new Prostate Cancer Precision Health Africa1K Health Equity Research Outcomes and Improvement Consortium has been tasked with addressing this gap. Initiating efforts in Southern Africa, with the highest globally recorded regional mortality rates, in this review we discuss our earliest observations, with the objective to share knowledge, encourage further inclusivity across Sub-Saharan Africa, while considering challenges and benefits. Most notably, and in contrast to regions of current scientific efforts, African nations not only represent extreme disparities in rural-urban transition, but our early data also suggests that this transition has direct impact on both genetic and nongenetic health determinants, with further translation into tumour genome disparities. Ultimately, we propose from this first-of-its-kind resource, that rural communities provide an unmet opportunity to control for cultural practices, regional movement, genetic ancestry, and environmental exposures to enhance African inclusion in prostate cancer health disparity studies.