Our firmware promises to be an excellent training tool for organ anastomosis. Considering the complexity and likely complications of MAPS, it is a sine qua non that the surgeon be highly experienced and skilled. Surgical simulation is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they can safely operate on humans.

Aims: Modern chemotherapy has improved the prognosis of stage IV colorectal cancer (CRC). However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis. We report our experience in this context. Methods: Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from a prospectively collected database. We assessed response to neoadjuvant chemotherapy (NACT), postoperative outcome, progression free survival (PFS), and overall survival (OS). Survival was estimated using Kaplan Meier analysis. Results: 21 patients were treated between 2007 and 2014. In sixteen patients (76%), NACT with a biological was administered and tumor response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence and resectability of the disease. Median peritoneal cancer index was 5 (range: 3e10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 42 hepatic lesions with a median of 2 per patient (range: 1e2) and a median size of 1.5 cm (range: 0.8e2.8). Tumor necrosis >50% was recorded in 7 (33%) patients. Median hospital stay was 17 days (range: 14e24); severe morbidity (Dindo-Clavien grade III-IV) occurred in 24% and no perioperative mortality (0e90 days) was recorded. The median OS was 49 months (95% confidence interval, 31.5e66.5) while the median PFS was 7 months (95% confidence interval, 5e9). Conclusions: Combined parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy may be warranted in a selected group of patients with LM and PC from colorectal cancer allowing low morbidity and a good mid-term overall survival. Aims: Acute-on-chronic liver failure (AoCLF) is defined as acute deterioration of liver function in cirrhotic patients, following variceal bleeding, infection, binge drinking or surgery. It carries poor prognosis, with in-hospital mortality 50%e66%. Several extracorporeal liver support systems have been developed and in recent meta-analyses there was shown the decrease of mortality in AoCLF as compared with standard medical treatment (SMT).Aim: to present the results of treatment of patients with AoCLF with the use of Prometheus FPSA device, compared to STM group. Methods: From 2003 to 2012 103 patients with AoCLF underwent all together 257 FPSA procedures. This group was compared to the historical group AoCLF patients (n = 31), treated in the period 2000e2003, with SMT. There were no differences in: gender (45F/58M vs 16/15, p = 0,5), age (45 vs 43, p = 0,09), MELD (3510 vs 2914, p = 0,04), Child-Pugh score (122 vs 122), creatinine 2,612,03 vs 2,241,94, p = 0,2), INR (2,631,53 vs 2,241,69, p = 0,8), albumin (2,610,68 vs 2,540,79, p = 0,7), grade of encephalopathy (p = 0,99); the only difference was bilirubin (30,016,88 vs 16,0913,01, p < 0,05) -for FPSA and SMT groups respectively. The most common indication to FPS...

Aim: Gum chewing is known to accelerate gastric emptying. This prospective study aimed to analyse effect of gum chewing following Pancreaticoduodenectomy (PD) with Pancreaticogastrostomy (PG), using historical control as comparison. Materials and methods: Between April 2014 and August 2014, 20 PD patients were managed with chewing gum protocol (chew sugarless gum for 30 minutes 8th hourly), compared with an equal number of matched historical controls treated by traditional protocol. Results: Both groups were comparable in demographic, preoperative, operative, postoperative variables.On statistical univariate analysis, DGE and its grading was significantly reduced (p = 0.031) in chewing gum intervention group, they were able to tolerate liquid (p = 0.005) and solid diet (p = 0.006) earlier, and passed stools earlier (4.7 vs 5.6 days, p = 0.007) with reduced post-operative stay (15 vs 20.35 days, p = 0.005), with no differences in morbidity and mortality in both groups. On multivariate analysis, gum chewing significantly reduced the incidence of DGE (time to removal of Nasogastric Tube, resumption of solid diet), time to passage of first flatus/first stool, post-operative stay. Gum chewing did not influence vomiting/abdominal distension, reinsertion of nasogastric tube, length of ICU stay. Electrogastrogram analysis showed an increase in gastric motility during gum chewing in the test group. Conclusion: Gum chewing following PD is easy, cheap, without any adverse events, significantly associated with early recovery of bowel function, reduced DGE and reduced hospital stay. Further research would clarify this effect. , i.e. the loss of skeletal muscle mass, is increasingly recognized as a risk factor for complication after major abdominal surgery. The aim of this study was to determine the predictive value of sarcopenia in the development of surgical complications after pancreatoduodenectomy. 183 consecutive patients undergoing pancreatoduodenectomy at our institution were included. 162 patients were operated for malignancy and 21 for benign disease. Patients operated for chronic pancreatitis were excluded from analysis. Sarcopenia was determined by measuring the skeletal muscle index on a pre-operative CT-scan. Sarcopenia was defined at a threshold of 52.4 cm 2 /m 2 for males and 38.9 for females. Patient files were reviewed for perioperative morbidity/mortality and survival. Complications were scored according to ClavieneDindo. Post-operative pancreatic fistulas were scored according to the ISGPF definition.A majority of patients (N = 154; 84%) were classified as sarcopenic. Fistulas occurred in 50 patients with sarcopenia, and 1 without (32% vs 3.4%; p < 0.0001). Grade B or C fistulas occurred in 33 vs 1 patients (21% vs 3.4%; p = 0.02). There was no significant difference in hospital stay, occurrence of Clavien >2 complications or perioperative mortality. By multivariate analysis, the only independent predictors of post-operative pancreatic fistulas were sarcopenia (p = 0.001) and soft pancreatic texture (p = 0.0...

Socio-economic status in pancreatic-cancer patients determined likelihood for surgical treatment. SES had no influence on survival. It is important to provide more insights in the causes of these inequalities to ultimately minimalize the effects of SES in pancreatic-cancer care.