Older patients have similar peri-operative outcomes and five-year survival compared to younger counterparts after PD in a UK tertiary centre, and should be considered for surgical resection of pancreatic and periampullary cancers.

Emergency coronary artery bypass is associated with increased operative mortality. The objective of this study was to evaluate the efficiency and safety of off-pump emergency coronary artery bypass, and to compare the outcome with that of the conventional on-pump procedure. Data of 79 patients who underwent emergency isolated coronary artery bypass were reviewed retrospectively; 45 had off-pump coronary bypass and 34 had conventional surgery. In the off-pump group, mean ejection fraction was significantly lower (28% +/- 9% vs. 39% +/- 10%), and there were fewer grafts per patient (1.8 +/- 0.7 vs. 3.2 +/- 0.8). Early mortality was higher in the conventional surgery group (14.7% vs. 8.9%), but late mortality was similar in both groups. Patients who had on-pump surgery had lower rates of recurrent angina (16% vs. 34%) and symptoms of heart failure (20% vs. 51%). Re-hospitalization was more common in off-pump patients, but cardiac re-interventions were similar. There was no significant difference in 5-year survival rates. The results of off-pump coronary bypass were better than the preoperative predicted EuroSCORE, thus it was concluded that patients treated on an emergency basis should have an off-pump revascularization procedure.

Patients with BMI ≥ 30 are at an increased risk of developing pancreatic fistula following PD. Obesity does not appear to have an impact on long term outcomes in patients undergoing a PD for adenocarcinomas.

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was increased for cystic lesions and lesions <2 cm. For cystic lesions <2 cm, diagnostic accuracy was increased when CT+MRI+EUS+FNA were used. In the 94 patients with misdiagnosis, surgery was ultimately clinically relevant (MT, PMT or symptomatic BT) in 48 but was inappropriate in 46 (5%). In these 46, multivariate analysis identified age <50 y., familial history of cancer and cystic tumor as risk factors of misdiagnosis. Conclusions: Accurate preoperative diagnosis is presently possible for 89% of PT. Misdiagnosis leads to inappropriate surgery in only 5% of cases. For cystic tumors <2 cm, to increase number of preoperative examinations could increase diagnostic accuracy.