Basic to surgery about pancreatics

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I now have extensive content from Current Surgical Therapy 14e. Let me compile a thorough, well-organized response on the basics of surgery of the pancreas.

Basics of Surgery of the Pancreas

Based primarily on Current Surgical Therapy 14e, Mulholland & Greenfield's Surgery 7e, and Sabiston Textbook of Surgery.

1. Surgical Anatomy

The pancreas is a retroperitoneal organ divided into four regions:

Head - lies within the C-loop of the duodenum; the uncinate process projects posterior to the superior mesenteric vessels
Neck - overlies the superior mesenteric vein (SMV) and portal vein confluence
Body - crosses the spine at L1-L2
Tail - extends to the splenic hilum

Key relationships for the surgeon:

The portal vein forms behind the neck of the pancreas from the confluence of the SMV and splenic vein
The superior mesenteric artery (SMA) lies just left of the SMV
The common bile duct runs through or behind the head of the pancreas before joining the pancreatic duct at the ampulla of Vater
The gastroduodenal artery (GDA) descends anterior to the pancreatic head

2. Surgical Exposure of the Pancreas

Anterior Exposure

The stomach is elevated and the transverse colon retracted caudally. An avascular plane on the left side of the omentum is entered to reach the lesser sac. The gastrocolic ligament is divided with an energy device (LigaSure/Harmonic Scalpel). The hepatic flexure of the right colon can be mobilized inferiorly for wider access. The SMV is identified by following venous tributaries as they cross the third portion of the duodenum.

Posterior Exposure

Kocher maneuver - incises the peritoneum lateral to the duodenum and sweeps the duodenum and pancreatic head medially to expose the inferior vena cava and aorta behind the head. The duodenum and pancreatic head are mobilized to the level of the left renal vein.
Medial rotation of the spleen - for the body and tail, the white line of Toldt along the left colon is mobilized, splenic attachments to the diaphragm and colon are divided, allowing the spleen and distal pancreas to be rotated medially.

3. Major Pancreatic Operations

3a. Pancreaticoduodenectomy (Whipple Procedure)

The most common operation for tumors of the periampullary region. Removes the pancreatic head, duodenum, gallbladder, and common bile duct, with or without the gastric antrum.

Six operative steps (Current Surgical Therapy 14e):

Define the infrapancreatic SMV - Enter the lesser sac, incise the visceral peritoneum along the inferior border of the pancreas, expose the SMV and its junction with the middle colic vein.
Mobilize the duodenum and pancreatic head - Kocher maneuver to the level of the left renal vein; dividing the posterior peritoneum facilitates later SMA dissection.
Portal dissection - Identify the common hepatic artery, remove the hepatic artery lymph node, perform cholecystectomy top-down, and divide the common hepatic duct above the cystic duct confluence.
Divide the stomach or duodenum - Standard Whipple: divide the antrum. Pylorus-preserving Whipple (PPPD): divide the duodenum 2 cm distal to the pylorus.
Divide the pancreatic neck - Pass a tunnel posterior to the pancreatic neck over the SMV/portal vein and divide the neck with electrocautery or a stapler.
Divide the uncinate process - Separate the uncinate from the SMA using a systematic SMA-first approach; the SMA margin is the most common site of positive resection margins.

Reconstruction (hepaticojejunostomy + pancreaticojejunostomy + gastrojejunostomy):

Pancreaticojejunostomy or pancreaticogastrostomy for the pancreatic remnant
Hepaticojejunostomy for the bile duct
Gastrojejunostomy (antecolic preferred over retrocolic to reduce delayed gastric emptying)

Complications:

Complication	Key Points
Pancreatic fistula/POPF	Most common major complication; soft gland texture and small duct are risk factors
Delayed gastric emptying	Lower with antecolic gastrojejunostomy; treat with prokinetics (erythromycin or metoclopramide)
Postpancreatectomy hemorrhage	Early = technical failure; Late (POD 7-14) = pseudoaneurysm (often from pancreatic fistula); treat with interventional radiology embolization
Bile leak	Hepaticojejunostomy failure

Diagnostic laparoscopy before laparotomy is recommended - approximately 10% of patients will have small metastatic deposits not seen on preoperative imaging.

3b. Distal Pancreatectomy

Resection of the body and tail of the pancreas, most often for tumors of the body/tail, trauma, or chronic pancreatitis.

Key steps:

Posterior exposure via medial rotation of the spleen from retroperitoneal attachments
Isolate and ligate the splenic artery and vein individually where possible
If hemodynamically unstable (trauma), fire a linear cutting stapler across the splenic vessels, then a second fire across the pancreas
Oversew the transected pancreatic stump with overlapping 3-0 absorbable U-stitch sutures; oversew the duct if visible
Wide external drainage of the pancreatic bed (high leak rate with soft gland)

Splenectomy: Most surgeons perform splenectomy routinely with distal pancreatectomy. Splenic preservation adds significant operative time and is reserved for stable patients operated on by experienced surgeons. Post-splenectomy vaccination (pneumococcus, meningococcus, Haemophilus influenzae) is required.

3c. Total Pancreatectomy

Removes the entire pancreas. Indications include multifocal IPMN with high-grade dysplasia throughout the gland, diffuse PDAC, or failure of the pancreatic remnant.

Consequence: Total endocrine and exocrine insufficiency - the patient becomes a brittle diabetic and requires lifelong pancreatic enzyme replacement.

4. Pancreatic Pathology Requiring Surgery

4a. Pancreatic Ductal Adenocarcinoma (PDAC)

5-year survival ~10% - most patients present with unresectable disease
Key biomarker: CA 19-9 (sensitivity and specificity ~80%); pre-op levels correlate with resectability
Resectability criteria (NCCN):
- Resectable - no arterial involvement, less than 180° contact with SMV/portal vein
- Borderline resectable - limited arterial contact or >180° venous contact; neoadjuvant therapy first
- Locally advanced/unresectable - >180° arterial involvement
Chemotherapy regimens: FOLFIRINOX or Gemcitabine + nab-paclitaxel
Germline testing recommended (BRCA1/2, PALB2, etc.) - implications for PARP inhibitor therapy

4b. Intraductal Papillary Mucinous Neoplasm (IPMN)

Most commonly resected cystic neoplasm. Accounts for ~10% of all pancreatectomies in the US.

Classification by duct involvement:

Type	Definition	Risk of invasive carcinoma
Main duct (MD-IPMN)	Main duct dilation >5 mm	Up to 64%
Branch duct (BD-IPMN)	Cysts >5 mm communicating with main duct	≤18%
Mixed type	Both features present	Intermediate

Fukuoka 2017 guidelines - "High-risk stigmata" mandating resection:

Main duct dilation >10 mm
Obstructive jaundice with cystic lesion in the head
Enhanced solid component within cyst (mural nodule)

"Worrisome features" (require close follow-up or EUS-FNA): cyst >3 cm, thickened enhanced cyst walls, main duct 5-9 mm, non-enhanced mural nodule, abrupt change in duct caliber, lymphadenopathy.

4c. Pancreatic Neuroendocrine Tumors (PNETs)

Account for 3% of pancreatic malignancies
Can be functional (insulinoma, gastrinoma, glucagonoma, VIPoma) or non-functional
WHO grading based on Ki-67 index and mitotic rate
Chromogranin-A (CHGA) is the principal biomarker
Associated with hereditary syndromes: MEN1 (most common), VHL, neurofibromatosis type 1, tuberous sclerosis

4d. Mucinous Cystic Neoplasm (MCN)

Almost exclusively in women (>95%); located in body/tail
Do not communicate with the main pancreatic duct (distinguishes from IPMN)
Have "ovarian stroma" histologically
All MCNs should be resected (distal pancreatectomy) due to malignant potential

4e. Autoimmune Pancreatitis (AIP)

A surgical pitfall - can mimic PDAC clinically and radiologically.

Type I AIP: Elevated serum IgG4, lymphoplasmacytic sclerosing pancreatitis - responds dramatically to glucocorticoids
Type II AIP: IgG4 normal, idiopathic duct-centric pancreatitis - also steroid-responsive
A steroid trial (prednisolone 40 mg/day x 2 weeks) can confirm AIP and avoid unnecessary Whipple resection

5. Pancreatic Trauma

AAST Grading of Pancreatic Injuries

Grade I/II - Contusion or laceration without duct injury - manage conservatively with closed suction drainage
Grade III - Distal transection or laceration with duct injury - distal pancreatectomy
Grade IV/V - Proximal ductal injury or severe disruption of the pancreatic head

Ductal assessment:

MRCP is the preferred non-invasive method to assess ductal integrity
Intraoperative: direct inspection, methylene blue injection, intraoperative ERCP
Findings suggesting duct disruption: complete transection, laceration >50% of pancreatic diameter, severe maceration

For proximal (head) injuries: Pancreatoduodenectomy (trauma Whipple) is indicated for near-complete destruction of the duodenum/pancreatic head, proximal duct + CBD + duodenal injury, or ampullary injury. The initial operation should achieve hemorrhage control and GI contamination control only; formal reconstruction is delayed (damage control surgery approach).

6. Pancreatic Fistula (Key Post-op Complication)

Defined by the International Study Group for Pancreatic Surgery (ISGPS):

Biochemical leak (Grade A) - drain amylase >3x upper limit of normal on POD3 with no clinical impact
Grade B - clinical impact requiring change in management (prolonged drainage, antibiotics, endoscopic/radiologic intervention)
Grade C - life-threatening, requires reoperation

Risk factors for POPF: Soft pancreatic texture, small pancreatic duct (<3 mm), high BMI, non-PDAC pathology.

Summary

The key surgical operations for the pancreas are the Whipple procedure (pancreaticoduodenectomy) for head/periampullary lesions, distal pancreatectomy for body/tail lesions, and total pancreatectomy for diffuse disease. The main surgical challenges are:

Safe vascular dissection around the SMV/portal vein/SMA
Prevention and management of pancreatic fistula
Patient selection (resectable vs. borderline resectable disease)
Distinguishing malignant from benign or premalignant conditions (especially IPMN and AIP)

Sources: Current Surgical Therapy 14e (Cameron & Cameron) | Mulholland & Greenfield's Surgery 7e | Sabiston Textbook of Surgery | Robbins & Kumar Basic Pathology

In mind map approach

Reading File

Running Command

mkdir -p /home/daytona/workspace/pancreas-mindmap && ls /home/daytona/workspace/pancreas-mindmap

Writing File

~/pancreas-mindmap/mindmap.js

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// ─── SLIDE 2: WHIPPLE PROCEDURE DETAIL ────────────────────────────────────────
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    { n: "1", title: "Infrapancreatic SMV", body: "Enter lesser sac → expose SMV below pancreatic neck\nIdentify middle colic vein junction" },
    { n: "2", title: "Kocher Maneuver", body: "Mobilise duodenum & pancreatic head medially\nExpose IVC, left renal vein, aorta" },
    { n: "3", title: "Portal Dissection", body: "Identify common hepatic artery\nTop-down cholecystectomy\nDivide CHD above cystic duct" },
    { n: "4", title: "Divide Stomach/Duodenum", body: "Standard: divide antrum\nPylorus-preserving (PPPD): 2 cm distal to pylorus" },
    { n: "5", title: "Divide Pancreatic Neck", body: "Tunnel posterior to neck over SMV/portal vein\nDivide with electrocautery or stapler" },
    { n: "6", title: "Uncinate Process / SMA", body: "SMA-first approach\nSMA margin is most common site of positive margin" },
  ];

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// ─── SLIDE 3: PATHOLOGY MIND MAP ──────────────────────────────────────────────
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    {
      name: "PDAC", color: C.branch2,
      x: 0.2, y: 0.6,
      facts: ["5-yr survival ~10%", "CA 19-9 (sens/spec ~80%)", "FOLFIRINOX or Gem + nab-PTX", "Resectable / Borderline / Locally adv.", "SMA margin most critical", "Germline testing (BRCA1/2)"],
    },
    {
      name: "IPMN", color: C.branch6,
      x: 3.55, y: 0.6,
      facts: ["Most common resected cyst", "Main duct: up to 64% malignant", "Branch duct: ≤18% malignant", "Fukuoka 2017 guidelines", "High-risk: MPD >10mm, jaundice, nodule", "Surgery vs surveillance"],
    },
    {
      name: "MCN", color: C.branch3,
      x: 6.9, y: 0.6,
      facts: ["Almost exclusively women", "Body / tail location", "Ovarian stroma histology", "No duct communication", "ALL should be resected", "Distal pancreatectomy"],
    },
    {
      name: "PNETs", color: C.branch5,
      x: 10.25, y: 0.6,
      facts: ["3% of pancreatic malignancies", "Functional vs non-functional", "Chromogranin-A biomarker", "WHO grade: Ki-67 + mitotic rate", "MEN1, VHL syndromes", "Enucleation or resection"],
    },
    {
      name: "Autoimmune\nPancreatitis", color: C.branch4,
      x: 0.2, y: 4.2,
      facts: ["Mimics PDAC clinically", "Type I: IgG4 elevated (LPSP)", "Type II: IgG4 normal (IDCP)", "Steroid trial confirms diagnosis", "Prednisolone 40 mg × 2 wk", "Avoid unnecessary Whipple"],
    },
    {
      name: "Serous Cystadenoma", color: "7BB3CC",
      x: 3.55, y: 4.2,
      facts: ["Benign - no malignant potential", "Honeycomb / microcystic pattern", "VHL mutation associated", "Often no surgery needed", "Observe unless symptomatic", "Central scar on CT (classic)"],
    },
    {
      name: "Solid Pseudopapillary\nNeoplasm (SPN)", color: "B08AC9",
      x: 6.9, y: 4.2,
      facts: ["Young women predominantly", "CTNNB1 mutation (beta-catenin)", "Low malignant potential", "Resection is curative", "Good prognosis even if large", "Distal Px-ectomy or Whipple"],
    },
    {
      name: "Chronic\nPancreatitis", color: "D4A96A",
      x: 10.25, y: 4.2,
      facts: ["Pain is main indication", "Frey or Beger procedure", "Lateral pancreaticojejunostomy", "Puestow procedure (historic)", "Ductal dilation >7 mm favors drainage", "Total Px for refractory pain"],
    },
  ];

  diseases.forEach(d => {
    // Header
    s.addShape(pres.ShapeType.roundRect, {
      x: d.x, y: d.y, w: 3.1, h: 0.5,
      fill: { color: d.color },
      line: { color: d.color },
      rectRadius: 0.1,
    });
    s.addText(d.name, { x: d.x, y: d.y, w: 3.1, h: 0.5, fontSize: 10.5, bold: true, color: C.dark, align: "center", valign: "middle", fontFace: "Calibri" });

    // Fact box
    s.addShape(pres.ShapeType.roundRect, {
      x: d.x, y: d.y + 0.52, w: 3.1, h: 3.3,
      fill: { color: "162535" },
      line: { color: d.color, width: 1.2 },
      rectRadius: 0.08,
    });
    d.facts.forEach((f, i) => {
      s.addShape(pres.ShapeType.ellipse, {
        x: d.x + 0.12, y: d.y + 0.7 + i * 0.5, w: 0.12, h: 0.12,
        fill: { color: d.color }, line: { color: d.color },
      });
      s.addText(f, {
        x: d.x + 0.3, y: d.y + 0.62 + i * 0.5, w: 2.75, h: 0.45,
        fontSize: 8.5, color: C.white, fontFace: "Calibri", valign: "middle",
      });
    });
  });
}

// ─── SLIDE 4: COMPLICATIONS ───────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.bg };

  s.addText("POST-PANCREATECTOMY COMPLICATIONS", {
    x: 0, y: 0, w: 13.3, h: 0.45,
    fontSize: 16, bold: true, color: C.branch4,
    align: "center", valign: "middle",
    fontFace: "Calibri", charSpacing: 2,
    fill: { color: "162535" },
  });

  const comps = [
    {
      title: "PANCREATIC FISTULA (POPF)",
      color: C.branch4,
      x: 0.3, y: 0.6,
      items: [
        "Definition: drain amylase >3× ULN on POD 3",
        "Grade A (Biochemical leak) — no clinical impact",
        "Grade B — change in management required",
        "Grade C — life-threatening, needs re-op",
        "Risk: soft gland, small duct (<3mm), high BMI",
        "Pasireotide shown to reduce POPF (N Engl J Med 2014)",
      ],
    },
    {
      title: "DELAYED GASTRIC EMPTYING (DGE)",
      color: C.branch6,
      x: 4.65, y: 0.6,
      items: [
        "Most common non-surgical complication",
        "Lower with antecolic gastrojejunostomy",
        "Rule out subclinical POPF or abscess (CT scan)",
        "Upper GI series to assess gastric emptying",
        "Treatment: NG tube + prokinetics",
        "Erythromycin or metoclopramide; usually self-limiting",
      ],
    },
    {
      title: "POSTPANCREATECTOMY HEMORRHAGE",
      color: C.branch2,
      x: 9.0, y: 0.6,
      items: [
        "Early (<24 h): technical failure → re-operation",
        "Late (POD 7–14): pseudoaneurysm or GJ ulcer",
        "Often triggered by adjacent pancreatic fistula",
        "Presents as herald bleed in drain or GI bleed",
        "Treatment: IR embolization or stenting",
        "Mortality 10–16%; risk of hepatic abscess",
      ],
    },
    {
      title: "BILE LEAK",
      color: C.branch3,
      x: 0.3, y: 4.1,
      items: [
        "Hepaticojejunostomy failure",
        "Often managed with percutaneous drainage",
        "ERCP + stenting if accessible anastomosis",
        "Grade A/B: non-operative management",
        "Grade C: reoperation required",
      ],
    },
    {
      title: "ENDOCRINE INSUFFICIENCY",
      color: C.center,
      x: 4.65, y: 4.1,
      items: [
        "Follows total pancreatectomy",
        "Brittle diabetes (no glucagon counter-regulation)",
        "Hypoglycaemia risk is severe",
        "Long-acting insulin + CGM monitoring",
        "Pancreatic islet autotransplantation option",
      ],
    },
    {
      title: "EXOCRINE INSUFFICIENCY",
      color: C.branch5,
      x: 9.0, y: 4.1,
      items: [
        "After extensive pancreatectomy",
        "Steatorrhoea, fat malabsorption, weight loss",
        "Pancreatic enzyme replacement therapy (PERT)",
        "Take enzymes with meals and snacks",
        "Fat-soluble vitamin supplementation",
      ],
    },
  ];

  comps.forEach(c => {
    // Header
    s.addShape(pres.ShapeType.roundRect, {
      x: c.x, y: c.y, w: 4.0, h: 0.48,
      fill: { color: c.color },
      line: { color: c.color },
      rectRadius: 0.1,
    });
    s.addText(c.title, { x: c.x, y: c.y, w: 4.0, h: 0.48, fontSize: 9.5, bold: true, color: C.dark, align: "center", valign: "middle", fontFace: "Calibri" });

    // Body box
    s.addShape(pres.ShapeType.roundRect, {
      x: c.x, y: c.y + 0.5, w: 4.0, h: 2.8,
      fill: { color: "162535" },
      line: { color: c.color, width: 1.2 },
      rectRadius: 0.08,
    });
    c.items.forEach((item, i) => {
      s.addShape(pres.ShapeType.ellipse, {
        x: c.x + 0.12, y: c.y + 0.72 + i * 0.42, w: 0.1, h: 0.1,
        fill: { color: c.color }, line: { color: c.color },
      });
      s.addText(item, {
        x: c.x + 0.28, y: c.y + 0.65 + i * 0.42, w: 3.65, h: 0.4,
        fontSize: 8.5, color: C.white, fontFace: "Calibri", valign: "middle",
      });
    });
  });
}

// ─── SLIDE 5: TRAUMA MIND MAP ─────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.bg };

  s.addText("PANCREATIC TRAUMA — MANAGEMENT ALGORITHM", {
    x: 0, y: 0, w: 13.3, h: 0.45,
    fontSize: 16, bold: true, color: C.branch5,
    align: "center", valign: "middle",
    fontFace: "Calibri", charSpacing: 2,
    fill: { color: "162535" },
  });

  // Central question
  s.addShape(pres.ShapeType.roundRect, {
    x: 4.65, y: 0.65, w: 3.6, h: 0.6,
    fill: { color: C.branch5 },
    line: { color: C.branch5 },
    rectRadius: 0.1,
  });
  s.addText("PANCREATIC INJURY IDENTIFIED", {
    x: 4.65, y: 0.65, w: 3.6, h: 0.6,
    fontSize: 11, bold: true, color: C.dark, align: "center", valign: "middle", fontFace: "Calibri",
  });

  // Duct assessment box
  s.addShape(pres.ShapeType.roundRect, {
    x: 4.65, y: 1.45, w: 3.6, h: 0.6,
    fill: { color: "162535" },
    line: { color: C.branch5, width: 1.5 },
    rectRadius: 0.1,
  });
  s.addText("Ductal integrity?  →  MRCP / intraop fluoroscopy", {
    x: 4.65, y: 1.45, w: 3.6, h: 0.6,
    fontSize: 9, color: C.branch5, align: "center", valign: "middle", fontFace: "Calibri",
  });

  // Grade boxes
  const grades = [
    { grade: "Grade I–II", sub: "No duct injury", action: "Closed suction drain\nObservation\nNo resection needed", color: "7EC8A4", x: 0.4, y: 2.5 },
    { grade: "Grade III", sub: "Distal duct injury", action: "Distal pancreatectomy\n± Splenectomy\nOversew stump", color: C.branch5, x: 3.35, y: 2.5 },
    { grade: "Grade IV", sub: "Proximal duct injury", action: "Assess ampulla & CBD\nDamage control first\nDelayed reconstruction", color: C.branch2, x: 6.3, y: 2.5 },
    { grade: "Grade V", sub: "Massive head disruption", action: "Trauma Whipple\nDamage control → ICU\nReconstruct at re-look", color: "C0392B", x: 9.25, y: 2.5 },
  ];

  grades.forEach(g => {
    s.addShape(pres.ShapeType.roundRect, {
      x: g.x, y: g.y, w: 2.7, h: 0.5,
      fill: { color: g.color }, line: { color: g.color }, rectRadius: 0.1,
    });
    s.addText(g.grade, { x: g.x, y: g.y, w: 2.7, h: 0.5, fontSize: 11, bold: true, color: C.dark, align: "center", valign: "middle", fontFace: "Calibri" });

    s.addShape(pres.ShapeType.roundRect, {
      x: g.x, y: g.y + 0.52, w: 2.7, h: 0.38,
      fill: { color: "1A2D40" }, line: { color: g.color, width: 1 }, rectRadius: 0.06,
    });
    s.addText(g.sub, { x: g.x, y: g.y + 0.52, w: 2.7, h: 0.38, fontSize: 8.5, color: g.color, align: "center", valign: "middle", fontFace: "Calibri", italic: true });

    s.addShape(pres.ShapeType.roundRect, {
      x: g.x, y: g.y + 0.94, w: 2.7, h: 1.4,
      fill: { color: "162535" }, line: { color: g.color, width: 1.2 }, rectRadius: 0.08,
    });
    s.addText(g.action, { x: g.x, y: g.y + 0.94, w: 2.7, h: 1.4, fontSize: 9, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", wrap: true });
  });

  // Damage control principles
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 5.35, w: 12.7, h: 1.65,
    fill: { color: "1A2D40" }, line: { color: C.branch5, width: 1.5 }, rectRadius: 0.1,
  });
  s.addText("DAMAGE CONTROL PRINCIPLES", {
    x: 0.4, y: 5.38, w: 4.5, h: 0.35, fontSize: 10, bold: true, color: C.branch5, fontFace: "Calibri",
  });
  const dcItems = [
    "Haemorrhage control first — pack and leave",
    "GI contamination control — staple, don't anastomose",
    "Temporary abdominal closure",
    "Resuscitate in ICU: correct coagulopathy, hypothermia, acidosis",
    "Return for formal reconstruction at 24–48 h",
    "Pancreatic duct drainage: cannulate for external drainage if possible",
    "Whipple reconstruction delayed — ask HPB colleagues for assistance",
  ];
  dcItems.forEach((item, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i < 4 ? i : i - 4;
    s.addShape(pres.ShapeType.ellipse, {
      x: 0.45 + col * 6.4, y: 5.78 + row * 0.38, w: 0.1, h: 0.1,
      fill: { color: C.branch5 }, line: { color: C.branch5 },
    });
    s.addText(item, {
      x: 0.62 + col * 6.4, y: 5.72 + row * 0.38, w: 5.8, h: 0.35,
      fontSize: 8.5, color: C.white, fontFace: "Calibri",
    });
  });
}

// ─── WRITE FILE ────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/pancreas-mindmap/Pancreas_Surgery_MindMap.pptx" })
  .then(() => console.log("Done: Pancreas_Surgery_MindMap.pptx"))
  .catch(err => console.error("Error:", err));

Running Command

cd /home/daytona/workspace/pancreas-mindmap && node mindmap.js

Running Command

ls -lh /home/daytona/workspace/pancreas-mindmap/Pancreas_Surgery_MindMap.pptx

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