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Objective: The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers. Summary Background Data: PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection. Methods: This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998). Results: Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%. Conclusion: These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.

This article is a review of spondylolysis and spondylolisthesis in younger age groups. Since Herbinaux first described the pathology (1782), many classifications and theories of etiopathogenesis have been proposed. The congenital and isthmic types, as classified by Wiltse, are the most frequent in younger age groups, but the postsurgical progressive forms (3-5%) have been described as increasing in frequency secondary to neoplastic surgery in children. The general incidence is 4-5% at the age of 6 years, and in 30-50% of cases these types do not progress to spondylolisthesis. Most cases are asymptomatic (80%). Standard radiographic examinations (A-P, L, Oblique) are helpful in diagnosis and can suggest what the prognosis will be in terms of the evolution, and also what treatment is indicated (degree of slippage, slip angle, lumbar and lumbosacral index, SPTI). A bone scan (PBS and SPECT) is useful in the early stages of spondylolysis (pre-spondylosis). Although the CT scan is the most accurate examination, MRI is becoming important for diagnosis because of the frequency with which it is used as a primary investigation method. Depending on patient age, progression, degree of slippage, and symptoms, different therapeutic approaches have been proposed and are described in this paper.

Background: In times of modern surgery, transplantation and percutaneous techniques, pyogenic liver