Methods: We retrospectively reviewed the basis on which the diagnosis of cancer was established between 2004 and 2015 in the IKZ region. We identified all patients of whom the diagnosis was establish prior to or during surgery and those who were diagnosed post-operative. With that information we expected to discover that the macroscopic examination in the operating room, by the surgeon, suffices in a great number of cases. Results: Histological gallbladder examination occurred in 31902 patients and malignancy was diagnosed in 205 cases, 96 were found inoperable due to metastatic disease. In 34, the diagnosis or high suspicion was already made before the operation. In another 30 we found description of a tumour in the operation report. In just 38 there was no mention of a suspicious gallbladder appearance. Upon macroscopic examination in the pathology laboratories, abnormalities were seen in 23 of the 38. In the remaining 15, it was documented that the specimens were taken at random. Of these 15 cases, 8 were either acute cholecystitis, conversion or open procedure which would problably vanguard additional histopathologic inspection. Resulting in unexpected gallbladder malignancy in just 7 cases. Of these cases only 1 was referred for additional surgery. Conclusions: We presented one of the largest single study cohort of gallbladder cancer and histopathologic gallbladder specimens. The major part of the invasive gallbladder cancers showed macroscopic abnormalities perioperative. Therefore Sel-HP seems a feasible policy and would reduce costs and pathological workload.

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

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