This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e19. Learning Objective: Upon completion of this CME activity successful learners will be able to (1) evaluate the probability of a venous thromboembolism (VTE) in patients with newly diagnosed pancreatic ductal adenocarcinoma (PDAC); (2) identify the risk factors for VTE in patients with PDAC; and (3) assess the impact of VTE on survival in patients with PDAC. Venous Thromboembolism and Pancreatic CancerThe BACAP-VTE Study : pancreatic cancer patients prospectively followed-up from time of enrollment until last visit or death 152 patients (20.79%) developed a VTE during a median follow-up of 19.3 months Patients developing VTE during follow-up had lower PFS (HR 1.74, 95%CI 1.19-2.54, P=.004) Patients developing VTE during follow-up had lower OS (HR 2.02, 95%CI 1.57-2.60, P<.001).

Background: We previously showed that embolization of portal inflow and hepatic vein (HV) outflow (liver venous deprivation, LVD) promotes future liver remnant (FLR) volume (FLR-V) and function (FLR-F) gain.Here, we compared FLR-V and FLR-F changes after portal vein embolization (PVE) and LVD.Methods: This study included all patients referred for liver preparation before major hepatectomy over 26 months. Exclusion criteria were: unavailable baseline/follow-up imaging, cirrhosis, Klatskin tumor, twostage hepatectomy. 99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7, 14 and 21 after PVE or LVD. FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models (joint modelling) with/without missing data imputation.Results: Baseline FLR-F was lower in the LVD (n=29) than PVE group (n=22) (P<0.001). Technical success was 100% in both groups without any major complication. Changes in FLR-V at day 14 and 21 (+14.2% vs. +50%, P=0.002; and +18.6% vs. +52.6%, P=0.001), and in FLR-F at day 7, 14 and 21 (+23.1% vs. +54.3%, P=0.02; +17.6% vs. +56.1%, P=0.006; and +29.8% vs. +63.9%, P<0.001) differed between PVE and LVD group. LVD (P=0.009), age (P=0.027) and baseline FLR-V (P=0.001) independently predicted FLR-V variations, whereas only LVD (P=0.01) predicted FLR-F changes. After missing data handling, LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions: LVD is safe and provides greater FLR-V and FLR-F increase than PVE. These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.

Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

percutaneous therapeutic interventions under X-ray control were performed in patients with exudative complications. Results: Sensitivity, specificity and diagnostic accuracy of ultrasound imaging were respectively 84.7%, 73.4% and 78.8%. Sensitivity, specificity and diagnostic efficiency of cytological and microbiological examination of our data were, respectively, 86.9%, 95.2% and 91.6%. 737 miniinvasive percutaneous interventions were hold totaly. The implementation of miniinvasive percutaneous interventions helped to stop the disease process and to avoid open surgical procedures in 91.7% of cases. Conclusion: Fine-needle diagnostic puncture is a highly informative method for diagnosis of the nature and details of tissue damage and pathological process phase. The timely refining ultrasound diagnosis of various clinical and morphological forms of acute pancreatitis combined with diagnostic fine-needle puncture conducting allows to approach differentiately to the implementation of miniinvasive percutaneous interventions and to justify a strategic position in the surgical treatment of destructive pancreatitis.

Late complications arising after bile duct injury (BDI) include biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis. Secondary biliary cirrhosis resulting in associated hepatic failure or digestive tract bleeding due to portal hypertension is a substantial risk factor for morbidity and mortality after bile duct repair. Parameters that determine the management of late complications of BDI include the type of biliary injury, associated vascular injury, hepatic atrophy, the presence of intra-hepatic strictures or lithiasis, repetitive infectious complications, the quality of underlying parenchyma (fibrosis, secondary biliary cirrhosis) and the presence of portal hypertension. Endoscopic drainage is indicated for patients with uncontrolled acute sepsis, patients at high operative risk, patients with cirrhosis who are not eligible for liver transplantation and patients who have previously undergone several attempts at repair. Roux-en-Y hepaticojejunostomy, whether de novo or as an iterative repair, is the technique of reference for post-cholecystectomy BDI. Hepatic resection is indicated in only rare instances, mainly in case of extended hilar stricture, multiple stone retention in one sector of the liver or in patients for whom the repair is deemed technically difficult. Liver transplantation is indicated only in exceptional circumstances, when secondary biliary cirrhosis is associated with liver failure and portal hypertension.

Short-term results of RDP seem to be similar to LDP but the high cost of RDP makes this approach not cost-effective actually.

The type of arterial reconstruction used for arterial anastomosis during primary liver transplantation has an impact on the occurrence of early HAT. The use of a long graft artery is an independent risk factor of early HAT. Thereby, we recommend the use of a short graft artery with a direct path when feasible to reduce the occurrence of early HAT after primary liver transplantation.

Background: A recent survey revealed that many European surgeons have concerns about the oncological safety of minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC). Methods: A pan-European retrospective cohort study was performed on patients who underwent MIDP or open distal pancreatectomy (ODP) for PDAC (2007-2015). MIDP patients were matched to ODP patients (1:1) based on propensity scores obtained via multivariable logistic regression including only preoperatively variables: sex, age, BMI, ASA, prior abdominal surgery, surgery year, tumor location and size. Primary outcome was radical (R0) resection rate. Results: In total, 1336 patients were included from 33 centers in 11 countries. Mortality was 2% and median survival 29 months. Of 369(28%) MIDP patients, 239 could be matched to an ODP patient. Conversion rate was 21%(n=44). After matching, R0 resection rate was 66%(n=149) for MIDP vs 52%(n=119) for ODP (p=0.002), lymph node retrieval was 13(IQR=7-23) vs 19(IQR=12-26)(p<0.001), the use of adjuvant chemotherapy was 72% vs 67% (p=0.28) and median overall survival (31 vs 26 months (p=0.51). Major complication rate (Clavien-Dindo 3-4) was 16%(n=36) vs 24%(n=53)(p=0.06), 90-day mortality 1%(n=2) vs 2%(n=4)(P=0.44) and hospital stay 7(IQR=5-10) vs 9(IQR=7-14) days (p<0.001). Conclusion: This pan-European propensity score matched analysis suggests short term benefits for MIDP over ODP. A randomized controlled trial is, however, needed to confirm the oncologic safety of MIDP for PDAC.