Background This study aimed to evaluate the additional value of laparoscopic ultrasound (LUS) to staging laparoscopy (SL) for detecting occult liver metastases in patients with potentially resectable pancreatic head cancer. Methods A retrospective cohort study was performed including all patients who underwent SL and LUS between 2005 and 2016. LUS was performed during SL to detect liver metastases not found by preoperative imaging or visual inspection of the liver. Results Out of 197 patients, visual inspection during SL detected distant metastases in 29 (14.7%) patients. LUS was performed in 127 patients, revealing 3 additional liver metastases. The proportion of patients with unresectable disease after SL and negative LUS was 32.3%, which was similar to 36.6% of patients with unresectable disease after SL without LUS (difference 4.3%; 95% CI − 13-23%; P = 0.61). Sensitivity, specificity, and positive and negative predictive values of LUS to detect liver metastases were 30, 100, 100, and 94%, respectively. The proportion of patients with distant metastases diagnosed at SL significantly increased over time (P = 0.031). Conclusion The routine use of LUS during SL for patients with potentially resectable pancreatic head cancer cannot be recommended. Imaging should be repeated when significant delay occurs between index CT and the scheduled surgery.

Although pancreaticoduodenectomy (PD) outcomes have improved, it remains a procedure with high perioperative complications. Surgical site infection (SSI) is one of the most common complications after PD, but difficulty remains in identifying high-risk patients. We present a risk stratification tool to predict patients at highest risk for SSI. Methods: Data was retrospectively collected on all patients undergoing PD at a tertiary hospital (9/2011e8/2014). Univariate analysis was performed to determine factors individually associated with SSI. These were incorporated into a multivariate logistic regression model with receiver operating characteristics analysis. The resulting odds ratios were converted into a point system to create a SSI score with internal validation. Results: 679 patients underwent PD and were split into test (443 patients) and validation groups (236 patients). There was no difference in patient or perioperative demographics between groups. Thirty-day SSI was observed in 16.7% (n = 114). By univariate analysis, history of chemoradiation, pre-operative chemotherapy and/or radiation, bile stent, absence of a superficial wound vacuum device, and vascular resection were associated with SSI (all p < 0.05). On multivariable analysis, pre-operative bile stent or drain and neoadjuvant chemotherapy were independent predictors of SSI (all p < 0.001). Predicted risk of SSI using this score was 0%, 32%, and 64% for 0, 1, and 2 points, respectively (AUC = 0.73, R 2 = 0.93). The model performed equivalently in the validation group (AUC = 0.77, R 2 = 0.99). Conclusion: This novel, validated risk stratification score accurately predicts SSI risk after pancreaticoduodenectomy. Identifying patients with the highest risk of SSI can help target interventions to reduce SSI, such as superficial wound vacuum devices.