Backgrounds/Aims: Pancreaticoduodenectomy (PD) is the gold standard for the treatment of periampullary tumors. Many specialized centers have adopted the totally laparoscopic or hybrid laparoscopic PD (LPD). However, this procedure has not yet been standardized and serious debate is taking place towards its safety and feasibility. Herein, we report our recent experience whit hybrid-LPD. Methods: During 2019 in our department 56 PD were performed and 21 (37.5%) underwent hybrid-LPD. We have retrospectively reviewed the short-term outcomes of these patients. Results: Main indication was pancreatic adenocarcinoma (71,4%). The median operative time and intraoperative blood loss were respectively 425 min (range, 226 to 576) and 317 ml (range 60 to 800 ml). Conversion to an open procedure was required in 4 patients (19%): 2 with suspected vein involvement, 1 for mesenteric panniculitis and 1 for biliary injury. The post-operative complication rate was 42.8% (9/21). Regarding post-operative pancreatic fistula, three patients (14.2%) had grade B and 1 grade C (4.7%). Median length of hospital stay was 14 days (range 9-23) and 90-days mortality was 4.7%. The mean number of harvested lymph nodes was 17.7 (range 12 to 26). The rate of margins R0 was 80%; R1 ＞0＜1 mm was 10.5% and R1 0 mm was 9.5%. Conclusions: Hydrid-LPD is safe and feasible. Careful patient selection and increasing experience can reduce the risk of post-operative complications.

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Ablation Difficult Score (ADS) was calculated by giving 1 point for each identified feature. The study population was stratified in low risk with ADS 0, n 105 (17.9%), intermediate risk, ADS 1-2, n 411 (70.3%), and high risk, ADS 3, n 69 (11.8%). The ablation success rate was 95.2% in ADS 0, 86.4% in ADS 1-2 and 65.2% in ADS 3, p < 0.001. Conclusion:The proposed Ablation Difficult Score seems to be related with ablation success rate and could be a simple and useful tool for guiding the treatment decision making of HCC patients.

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