Background: Iatrogenic ureteral injury rare 0.3-1.5%. complication of abdominopelvic cancer surgery. We aimed to study the risk and management of ureteral injury among cancer patients.  Methods: Diagnosis can be achieved retrograde pyelography, ureteroscopy, CT, or intravenous urography. Results: Years 2000 to 2020, 2904 patients in the Department of Surgical oncology, Assuit University, and 47 ureteral injury cases were identified. (1.62), 4/231 cervical cancer, 9/611 ovarian cancer and 7/462 endometrial cancer.,11/818 colon cancer,12/620 rectal cancer, 1/11 prostatic cancer, 3/151 retroperitoneal sarcoma. 34% (radical abdominal hysterectomy 8.5% Wertheim hysterectomies 4%), colorectal surgery colectomy 25.5%, low anterior resection2.1% in radical prostatectomy and 6.4% in retroperitoneal tumor, intraoperative diagnosis 48.9%, 8.5% in laparoscopic surgeries, the distal third (53.2%),23.4% catheterization, complete transection 31.9%; partial 14.9%, ligation 8.5%, laceration in 19.1%, resection. 8.5%; and devascularization in 17%. Fever in 14.9%, abdominal or flank pain in 38.5%. Oligura in 6.4%, ileus in 19.3%, urinary leakage (vaginally or via abdominal wound) in 10.6% rise creatinine in 10.6%, hydronephrosis in 6.4%, urinoma in 27.7%, extravasation in 8.5% asymptomatic in 4.3%, 40.4% percutaneous nephrostomy. 19.1%primary repair Ureteroneocystostomy in (17%) Boari flap in 12.7%, Psoas hitch in 23.4% stenting in 14.9%, 8.5% ileum interposition, anastomosis to contralateral ureter in 4.3%, ureteral stricture 6.4%, ureterovaginal fistulas in 10.6%, acute renal failure 2.1%, peritonitis 4.3, urinary tract infection in 14.9%.Conclusions: The recognition and immediate repair of ureteral injuries early during the same procedure was highly desirable and to avoid a second operation.

Background: Artery first approach pancreatoduodenectomy (AFAPD) technique is one of the many modifications of the standard whipple procedure (sPD) thus enabling a complete dissection of the right side of this artery and of the portal vein, as well as a complete excision of the retroportal pancreatic lamina. Objective was to evaluate the clinical, perioperative and oncological outcomes of “artery first” approach compared with those of the traditional approach.Methods: Between 2010 and 2019, The present study includes two groups of patients. A first group of 28 patients with PD by “artery first” and a second group including 28 matched patients with PD by TAPD. Demographic characteristics (sex, age), intraoperative data (approach type, operative time, blood loss, intraoperative complications, need for vascular resections), histological diagnosis and pathology data (tumor location, TNM staging, tumor grading, tumor vascular invasion) and patient outcomes (postoperative length of stay, in-hospital postoperative mortality and morbidity, survival time) were collected.Results: There were no significant differences between the two groups regarding: total operative time (422 vs. 460.min, p=0.19), estimated blood loss (p=0.67), median length of stay (14 days in both groups) (p=0. 0.39), complication rates (32.1% and 35.7%) (p=0. 1.00), lymph node yield (22 and 21) and R0 resection rate (75% and 67.9%).  Conclusions: We concluded that artery first” offers similar operative time, intraoperative blood loss, R0 resection rates, lymph node yield and long-term survival as TAPD.

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