Materials and methods: We performed a retrospective research for 9298 patients, treated at First surgical department of University hospital Pleven for the period 2011e 2016. Results: With acute calculous cholecystitis were diagnosed 1208 patients (13%), and 619 (51,24%) were surgically treated. We had 91% matched in primary and final diagnosis and we apply Tokyo guideline criteria for acute cholecystitis management-2007. With mild gallstone cholecystitis were 589 patients and we treated them conservatively. The laparoscopic treatment was performed 96 hours after diagnosis of moderate cholecystitis with conversion rate of 1,2 % , the patients with severe cholecystitis with perforation and perivesical abscess were treated only by open emergency cholecystectomy. Conclusion: Diagnosis of acute calculouse cholecystitis is usually not a problem for experienced clinicians. It is more difficult to stage the inflammatory process, becouse that determines the therapeutic approach. The most commonly used imaging method is echography. The main reasons for this are: high diagnostic capabilities, harmlessness, low financial value without trouble tracking.

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similar to literature. However, most of old cases, we can obtain ras mutation status after first line therapy, so in the ras wild type tumors, first line anti-EGFR usage was lower than the current practice. Despite of low-percentage of anti-EGFR usage at first line, our results showed that the pts with left-sided primary, with first line anti-EGFR treatment, median OS was 39.3 months. In the pts with right sided primary, the OS difference between first line anti-EGFR and anti-VEGF treatments were not significant.

treatment received was compliant in 72% patients with advanced liver disease; poor performance status and financial constraints being main reasons for change from MDT plan. The median overall survival for the whole cohort was 5.6 months in patients receiving treatment compliant to guideline recommendations and 9.8 months in the noncompliant group (p¼NS). Conclusions: Treatment decisions are often tailored to the situation in clinical practice. Our experience showed that 72% of HCC patients were treated according to international treatment guidelines and there were clinical, patients' personal or socio-economic reasons for treatment discrepant from guidelines.

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