Methods: We retrospectively reviewed the basis on which the diagnosis of cancer was established between 2004 and 2015 in the IKZ region. We identified all patients of whom the diagnosis was establish prior to or during surgery and those who were diagnosed post-operative. With that information we expected to discover that the macroscopic examination in the operating room, by the surgeon, suffices in a great number of cases. Results: Histological gallbladder examination occurred in 31902 patients and malignancy was diagnosed in 205 cases, 96 were found inoperable due to metastatic disease. In 34, the diagnosis or high suspicion was already made before the operation. In another 30 we found description of a tumour in the operation report. In just 38 there was no mention of a suspicious gallbladder appearance. Upon macroscopic examination in the pathology laboratories, abnormalities were seen in 23 of the 38. In the remaining 15, it was documented that the specimens were taken at random. Of these 15 cases, 8 were either acute cholecystitis, conversion or open procedure which would problably vanguard additional histopathologic inspection. Resulting in unexpected gallbladder malignancy in just 7 cases. Of these cases only 1 was referred for additional surgery. Conclusions: We presented one of the largest single study cohort of gallbladder cancer and histopathologic gallbladder specimens. The major part of the invasive gallbladder cancers showed macroscopic abnormalities perioperative. Therefore Sel-HP seems a feasible policy and would reduce costs and pathological workload.

Mortality was significantly higher in patients with an isolated PE, compared to patients with a combination of PE and ICT (91% and 50%, respectively; P < 0.001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure.

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Background Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. Methods An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. Results In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. Conclusions In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials.

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Background. FOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC. Methods. The PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate. Results. Fourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3-4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3-4 toxicity. Conclusions. Outcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.Pancreatic ductal adenocarcinoma has very poor survival rates. Surgical resection with adjuvant chemotherapy offers the best survival but is only feasible in approximately 20 % of patients.