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.

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.

Background: The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow and the worldwide utilization and attitudes towards MIPR remain unknown. Methods: We developed an anonymous online survey (61 questions) in order to gain knowledge on opinions and use of both, laparoscopic and robot-assisted pancreatic resections. The survey was sent to all surgeon members of the 6 largest hepato-pancreato-biliary associations. Results: In total, 435 surgeons from 50 countries completed the survey. Responders performed a median of 22(IQR:0-450) pancreatic resections as primary surgeon

Background: Distal pancreatectomy with celiac artery resection (DPCAR) is in use for borderline-resectable pancreatic cancer. It is believed that considerable reduction of the liver arterial supply after DPCAR may cause severe liver ischemia. Although the artery reconstruction is not a problem anymore the decision to reconstruct artery has to be justified. To study liver collateral arterial supply after temporary CHA, right gastroepiploic and accessory/ replaced left hepatic arteries (a/rLHA). Methods: Arterial anatomy, diameters of CHA, proper hepatic (PHA), gastroduodenal(GDA) and pancreatoduodenal arteries(PDA) were registered before surgery in 110 consecutive patients with pancreatic body/tail cancer(n35), gastric cancer with pancreatic involvementn30) and liver tumors(n45)by CT. For DPCAR(n20) these data were obtained after surgery as well. Diameters of peripancreatic arteries and mean systolic blood velocity in hepatic arteries before and after CHA clamping were measured intraoperatively by Doppler ultrasound. Results: Pulse disappeared in 19 (17 %) cases after clamping of CHA,RGEA and aLHA/rLPA. Collateral arterial blood flow in the liver parenchyma was revealed in all cases. DPCAR led to increase of GDA, rRHA, PDA and RGEA blood flow in 0,9-12 times. Conclusion: Doppler ultrasound is a reliable modality for intraoperative assessment of liver arterial blood supply after DPCAR; Hepatic artery reconstruction may be necessary after DPCAR in case of disappearance of arterial US signal upon the liver parenchyma.

Introduction: Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a radiomics nomogram by integrating radiomics signature and clinical predictors to estimate overall survival(OS) in patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peripancreatic venous invasion. Method: Data on patients with pancreatic head adenocarcinoma and suspected peripancreatic invasion who underwent pancreatic resection with venous reconstruction were retrospectively collected from 2012 to 2016 at two academic institutions. A total of 396 radiomics features were extracted from pretreatment CE-CT images of each patient. Least absolute shrinkage and selection operator (LASSO) regression was applied to select optimal features and generate a radiomics signature. The radiomics nomogram was developed by integrating the radiomics signature and clinical predictors. The performance of radiomics nomogram validated in the cohort of patients of second institution. Result: Radiomics signatures were significantly associated with pancreatic head adenocarcinoma patients' survival time. The radiomics nomogram combined with clinical predictors(CA-199 value, Peripancreatic venous abnormalities and Lymph node staging) provided good predictive accuracy of survival on calibration curves. The C-index of the model in predicting overall survival (OS) was 0.836 for the validation cohort. Conclusion:The nomogram accurately predicted OS in patients with pancreatic head cancer with suspected peripancreatic venous invasion after attempted curative pancreatic resectional surgery. These findings might aid clinicians with treatment decision-making and improve precise medicine.