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Enhanced recovery after a liver resection appears to be safe, feasible and may reduce severe complications. However, the LOS was significantly influenced by patient age, open surgery and post-operative complications, but not by an ERP.

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Background: Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist.The purpose of this study was to evaluate safety and efficacy for HPD in European centers.Method: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed. Results: In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival. Conclusion:HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.

Introduction Preoperative jaundice is considered a relative contraindication to radical gallbladder cancer (GBC) resection due to poor prognosis and high postoperative morbidity. Recent reports have indicated that aggressive surgery may improve long‐term survival for patients with advanced GBC who present with obstructive jaundice. The current systematic review and meta‐analysis aimed to compare postoperative outcomes among jaundiced and non‐jaundiced patients with resectable GBC. Methods An electronic search was performed using several Medical Subject Headings terms: cholecyst, gallbladder, tumor, cancer, carcinoma, adenocarcinoma, neoplasia, neoplasm, jaundice, and icterus. Overall survival after surgery was the primary outcome; resectability and postoperative morbidity were the secondary outcomes. Results Overall survival was shorter among patients who presented with jaundice (Hazard ratio [HR]: 2.21, 95% confidence interval [CI], 1.64‐2.97; P < 0.001). Patients with jaundice were less likely to have resectable disease (odds ratio: 0.27, 95% CI, 0.17‐0.43; P < 0.001). The jaundice group had higher odds of postoperative morbidity, bile‐leak, and posthepatectomy failure versus the non‐jaundiced control group. Conclusions Radical surgery for GBC resection for patients presenting with obstructive jaundice was associated with reduced overall survival and increased postoperative morbidity. Jaundiced patients with advanced GBC should be considered for surgical resection but need careful evaluation and counseling before undertaking extensive surgical resection.

Aims: Aim of our study is to evaluate the impact of obesity on post-operative outcomes of Pancreatico-duodenectomy. Methods: Demography, operative and outcomes data were studied from a prospectively maintained database of PD patients at Southampton General Hospital from 2007e2013. Four hundred and four patients were identified, twelve patients with body mass index (BMI) <18 were excluded. Patients were divided into two groups according to BMI: BMI <30 (Group A, n = 314), BMI > = 30 (Group B, n = 76). Results: The two groups were comparable for age, weight loss, pancreatitis, diabetic state, smoking, alcohol history and jaundice. There was a tendency to female predominance in Group B compared to Group A (p = 0.04). Operative time (351 vs 374 mins, p = 0.041) and blood loss (667 vs 782 p = 0.1) was higher in Group B compared to Group A. There was no difference in consistency of pancreas (p = 0,942) and size of pancreatic duct (p = 0,844) between the two groups. There was no difference in the critical care stay (p = 0.776) or overall length of stay (p = 0.307) in Group A compared to Group B. Post-operative pancreatic fistula was more common in Group B (p = 0.034), and major pancreatic fistula (grade B and C) was more in the obese group (p = 0,036) but there was no difference in wound infection (p = 0.868), bleeding (p = 0.669), overall complications (p = 0.952) and mortality (p = 0,716). Conclusions: Obesity makes the PD surgery difficult with increase in operative time. It also leads to increase in postoperative pancreatic fistula. Thirty day mortality is not impacted by obesity.

Liver grafts from selected >70-year-old donors do not pose added organ-specific risks and thus have comparable transplantation outcomes.