The results of the present study suggest that the routine use of TachoSil after a liver resection does not reduce the overall complication rate compared with Surgicel application. However, TachoSil may be beneficial in a major hepatectomy.

IntroductionThe aim of the study was to evaluate whether Nutritional risk screening 2002 (NRS 2002) at hospital admission may predict postoperative mortality and complications within 90 days after elective liver resection for malignancy.Material and methodsA retrospective cohort study of a prospective database was performed. Two-hundred and three patients with elective liver resection for malignancy between 9 November 2007 and 27 May 2014 were included. Clinical data, NRS 2002, surgical procedures and histology were recorded. The primary endpoint was 90-day mortality. Complications were registered within 90 days postoperatively according to the Clavien-Dindo classification.ResultsThe 90-day mortality was 5.9% and the overall complication rate was 59.1%. Multivariate analysis identified NRS 2002 score ≥ 4 (odds ratio (OR) = 9.24; p = 0.005) and American Society of Anesthesiologists (ASA) score ≥ 3 (OR = 6.20; p = 0.009) as predictors of 90-day mortality. The 90-day mortality was 27.6% (8/29) for patients with both risk factors (NRS 2002 score ≥ 4 and ASA score ≥ 3) vs. 2.3% (4/174) for patients without or with only one risk factor (p < 0.001).ConclusionsIn the present study NRS 2002 score ≥ 4 and ASA score ≥ 3 were predictors of 90-day mortality after elective liver resection for malignancy.

The present study did not permit to demonstrate an impact of preoperative immunonutrition with Oral-Impact on postoperative complications after minor liver resection.

Introduction To study whether the implementation of a clinical pathway including some enhanced recovery after surgery (ERAS) items for pancreaticoduodenectomy (PD) in a low volume centre for pancreatic surgery was safe. Material and methods Patients undergoing elective PD within a clinical pathway between 1 October 2013 and 30 September 2019 were considered for the study and the outcome was compared between the first and second period of the study. The primary endpoint was the achievement of postoperative key targets of the protocol. Secondary endpoints were complications, mortality and readmissions within 90 days postoperatively, and postoperative hospital stay. Results Forty-five patients could be ana-lysed. The two groups were balanc-ed for demographic, clinical and histological variables. In the second period more patients achieved key targets: nasogastric tube removal at postoperative day (PoD) 2, oral fluidsat PoD 3, drain removal at PoD 5 and hospital discharge at PoD 9. The rates of postoperative complications, mor-tality and readmissions were not significantly different between the two groups and were similar to data reported for high volume centres. Conclusions Our results show that the implementation of a clinical pathway following PD and including some ERAS items was feasible and safe in a low volume centre for pancreatic surgery.