dMMR biliary tract cancers associated with LS are rare but long-term outcomes may be more favorable than contemporaneous cohorts of non-Lynch-associated cholangiocarcinomas. Given the emerging promise of immunotherapy for patients with dMMR malignancies, tumor testing for dMMR followed by confirmatory germline testing should be considered in patients with BTC and a personal history of other LS cancers.

Background: The optimal postoperative analgesic regimen for HPB surgery patients remains controversial. The primary objective of this single-center randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient controlled analgesia (PCA) for adequacy of pain control over the first 48 hours after surgery. Methods: Using a 2.5:1 randomization strategy, 140 patients undergoing HPB resections were randomized to TEA (N = 106) or PCA (N = 34). Patient-reported pain was measured on a Likert scale (0-10) at standard time intervals. Cumulative pain area under the curve (AUC) was determined using the trapezoidal method. Results: Demographic, comorbidity, clinical and operative variables, including incision type, operative time, EBL and postoperative drain placement were equivalent. The median AUC of the postoperative pain scores was significantly lower in the TEA group (81.15 vs 109.6, p = 0.029) with a 35% reduction in patients with pain episodes > = 7/ 10 (43% vs 66%, p = 0.05). Anesthesia related events were comparable (10.4% vs 3.1%, p = 0.29). Grade > = 3 surgical complications occurred in 7 TEA group patients (6.6%) and 3 PCA group patients (9.4%, p = 0.7). Median length of stay (6 days vs 6 days), readmission (1.9% vs 3.1%), and return to the OR (0.9 vs 3.1%) were similar (all p > 0.05). There were no mortalities. Conclusion: In major HPB surgery, TEA provides a superior patient experience through improved pain control without increased length of stay or complications.

Background: The aim of this study is to analyze prognostic factors for survival and recurrence in patients with diagnosis of digestive neuroendocrine tumours (DNT) and underwent a surgery and/or endoscopic resection Methods: Medical records of 85 patients with DNT were retrospectively reviewed since 1990-2016. The variables studied were: age, sex, form of presentation, localization, metastasis, treatment, type of surgery and state of tumour, including WHO classification (2010). Results: From 85 patients, 51.8% were male, with a median age of 61 years (29-81). By location, the most frequent tumour was small bowel DNT (27.1%) and appendix (25.9%). Appendicular tumours presents in youngest patients (39 years; 8-78) vs colon (67years; 36-83) (p = 0.004). Regarding the mode of presentation, it was sporadic (36.5%) and appendicitis (21.2%). Surgery was the most common treatment of primary tumour (73.5%) and endoscopic resection was enough in the 8.2%. There was synchronous metastasis in 37.6% (hepatic location 32.9%) and this presents association with location (small bowel and stomach; p < 0.001). The 1, 3 and 5-years survival was 89.3%, 75% and 58.4%. Univariate and multivariate survival analysis showed that location, presentation clinic, WHO classification and presence of metastasis are independent predictor factors. Conclusion: In our experience, location, presentation clinic, WHO classification and presence of metastasis were an independent prognostic factors in DNT survival.

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according with the onset or not of BS. Predictive factors for the onset of BS in univariate analysis were recipient female sex and ischemia time > 10 hrs; in a multivariate analysis including also donor sodiemia and hepatic artery thrombosis, female sex (p=0,018, OR 11.297, 95% CI 1,516-84,155) and ischemia time > 10 hrs (p=.028, OR 10,147, 95% CI 1,288-79,961) remained statistically significant. Conclusion: Biliary stenosis is confirmed as a main risk factor for the onset of BS after LT. In grafts with biliary stenosis predictive factors for BS are recipient female sex and ischemia time > 10 hrs.