Importance: While laparoscopic pancreaticoduodenectomy (LPD) is being adopted with increasing enthusiasm worldwide, it is still challenging for both technical and anatomical reasons. Currently, there is no consensus on the technical standards for LPD.Objective: The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review: An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy. Statements were produced upon reviewing the literature and assessed by the members of the expert panel. The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019. The Web of Science, Medline, and Cochrane Library and Clinical Trials databases were searched, The search strategy included, but was not limited to, the terms 'laparoscopic', 'pancreaticoduodenectomy, 'pancreatoduodenectomy', 'Whipple's operation', and 'minimally invasive surgery'. Reference lists from the included articles were manually checked for any additional studies, which were included when appropriate. Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements. The statements were further discussed during a one-day face-to-face meeting at the 1 st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan, China.Findings: Twenty-eight international experts from 8 countries constructed the expert panel. Sixteen statements were produced by the members of the expert panel. At least 80% of responders agreed with the majority (80%) of statements. Other than three randomized controlled trials published to date, most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument. Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD. LPD is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.

Various methods are applied in the treatment of fresh and neglected Monteggia fractures. The purpose of this retrospective study was to evaluate the efficacy of various treatment methods, and assess the complexity associated with missed radial head dislocation.All fracture patients were reviewed between Jan 2012 and Dec 2016. A detailed comparison was made of the treatment methods between fresh Monteggia fractures and neglected Monteggia fractures with missed diagnosis of dislocation.A preliminary analysis of clinical information from 1081 patients in our center was investigated, and 42 were included in the final analysis. The fresh group included 25 patients with an average Mayo Elbow Performance Score of 96.3 ± 2.7 and resulted in the following scores after treatment: 21 excellent, 3 good, and 1 fair. In the fresh group, 76% of patients received closed reduction. Treatment with a cast, elastic stable intramedullary nail, and the Kirschner wire stabilization with tension band wiring make up 80% of the choices for fixation treatment. No patients experienced associated vascular injuries, recurrent dislocation, or elbow dysfunction. The neglected group involved 17 patients with Mayo Elbow Performance Score of 92.1 ± 9.3 and resulted in the following scores after treatment: 10 excellent, 4 good, and 3 fair. The locking compression plate (LCP) was the most common choice for postoperative immobilization in the neglected group (88.2%). Three patients in the neglected group experienced recurrent dislocation.This retrospective analysis indicates that the treatment of neglected Monteggia fractures is more complex than that of fresh Monteggia fractures, and usually results in a worse recovery rate with a higher rate of recurrent dislocation and elbow dysfunction.

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Abbreviations & Acronyms ADT = androgen deprivation therapy BSA = bone sparing agent CI = confidence interval HR = hazard ratio mCSPC = metastatic castrationsensitive prostate cancer NE = not evaluable nmCRPC = non-metastatic castration-resistant prostate cancer OS = overall survival PC = prostate cancer PCWG2 = prostate cancer clinical trials working group 2 PFS2 = progression-free survival 2 PSA = prostate-specific antigen rPFS = radiographic progressionfree survival SAE = serious adverse event TEAE = treatment-emergent adverse event

Background A family history of pancreatic cancer is associated with increased pancreatic cancer risk. However, risk estimates for individuals in kindreds with an aggregation of pancreatic cancer (>1 relative) are imprecise due to small samples sizes or potentially impacted by biases inherent in retrospective data. Objective Determine the age-specific pancreatic cancer risk as a function of family history using prospective data. Methods We compared pancreatic cancer incidence (n = 167) in 21,141 individuals from 4,433 families enrolled in the National Familial Pancreatic Cancer Registry to that expected based upon Surveillance Epidemiology and End Results (SEER) data and estimated the cumulative probability of pancreatic cancer using competing risk regression. Results Familial pancreatic kindred members (FPC, kindreds with pancreatic cancer in two first-degree relatives or a pathogenic variant) had a standardized incidence ratio (SIR) of 4.86 (95% CI 4.01-5.90), and NFPTR sporadic kindreds members (SPC, kindreds not meeting familial criteria) had an SIR of 2.55 (95% CI 1.95-3.34). Risk in FPC kindreds increased with an increasing number of first-degree relatives with pancreatic cancer, with SIR of 3.46 (95% CI 2.52-4.76), 5.44 (95% CI 4.07-7.26), 10.78 (95% CI 6.87-16.89) for 1, 2 and 3 or more first-degree-relatives with pancreatic cancer, respectively. Risk was also higher among individuals with a family history of young-onset(<50) pancreatic cancer. Conclusion Pancreatic cancer risk is strongly dependent on family history, including both the degree-of-relationship(s) and age-of-onset of pancreatic cancer in relatives. These risk estimates will help inform the design of early detection studies and the risk/benefit analysis of screening trials.