BACKGROUND: The failure of pancreatic anastomosis after the proximal pancreaticoduodenectomy (PD) and the failure of pancreatic stump after the distal pancreatectomy with a resulting postoperative pancreatic fi stula remain the most feared complications after pancreatic resection. Surgeons have been trying to fi nd a reliable reconstructive technique of pancreatic anastomosis for decades. METHODS: A literature search was performed to January 2020. Studies giving a detailed description of the pancreatic anastomosis after open PD and pancreatic stump closure techniques after the distal pancreatectomy were included. The aim of this study was review reported data derived from meta-analyses concerning the incidence of POPF according to the International Study Group of Pancreatic Surgery. A comparison of various surgical techniques and their impact on POPF incidence was made. RESULTS: In the group of clinically relevant POPF (CR-POPF), a well established difference between the patients undergoing POPF-associated interventional drainage or reoperation was observed. Meta-analyses showed that the patients with CR-POPF were statistically more likely to have a small duct size, soft gland texture, particular pancreatic neoplasms and an excessive intraoperative blood loss. CONCLUSION: Grade C POPF following PD, although uncommon, occurs with a defi ned incidence and is associated with a substantial morbidity, prolonged hospitalization, delayed recovery and a signifi cant mortality. According to the results of various meta-analyses, pancreatogastrostomy and pancreatojejunostomy seemed to be comparable anastomotic techniques following PD (Ref. 54).

As any case of alleged medical malpractice, whether in a civil or criminal proceeding, cannot be resolved without involving the expert witness who assists the police, office of public prosecution or the court to rule on merits, the authorsaim to identify the most significant questionable and incorrect practices of expert witnesses based on the review of 11 years dataset (2008–2019) consisting of 3098 expert opinions and expert testimonies in both criminal and civil proceedings in Slovakia. To the necessary extent, the legal frameworkfor expert witnesses in Slovakia is also presented. The authors also aim to focus on the significant findings of the dataset, such as the most frequent specialities in which alleged malpractice occurred, which are surgery, emergency medicine, anaesthesiology and intensive care, gynaecology and obstetrics, internal medicine, neurology and paediatrics. The publication is also aimed at the most frequent incorrect or questionable practices of expert witnesses, such as ex-post case analysis, questionable practice related to the obtaining ofmedical records, improper use of consultants by the expert witness, misinterpretation of the autopsy records and autopsy diagnoses and the deficiencies in the processing the case file by the expert witness. The authors focused on important findings from the dataset, such as the specializations where the alleged medical malpractice most frequently occur-red, i.e. surgery, emergency medicine, anesthesiology and intensive care, gynaecology and obstetrics, internal medicine, neurology and paediatrics. The publication deals with the most common erroneous or questionable expertpractices, such as ex-post analysis of the case, questionable practice related to obtaining medical records, inappropriate selection of consultants by an expert, misinterpretation of documentation from post-mortem examinations and de-ficiencies in the preparation of an opinion based on the case file by a court expert.

The standard approach in the management of cutaneous malignant melanoma is considered to be a complete excision of the primary lesion with an appropriate margin of the normal tissue according to Breslow thickness. Usually sentinel lymph node biopsy (SLNB) can help to determine the nodal status, and thus improve the accuracy of staging of the disease. However, the role of SLNB in melanoma treatment remains controversial. NCCN guidelines strongly support routine performance of therapeutic lymphadenectomy in all melanoma patients with clinically positive nodes without radiographic evidence of distant metastases. Patients with positive SLNB should have had completion lymph node dissection (CLND) for regional disease control. Between 2012 and 2016, 168 consecutive patients underwent surgery for primary cutaneous malignant melanoma at St. Elisabeth Cancer Institute in Bratislava. The indication for SLNB and the procedure was made according to international guidelines. In this retrospective study, a cohort of 78 patients was analyzed (35 women and 43 men). Inclusion criteria comprised patients with cutaneous melanoma with no evidence of distant metastases or clinical lymphadenopathy. SLNB comprised a dual labelling method (Tc-99m Nanocolloid/blue dye) in a one-day protocol. Median follow-up was 657 days. The primary composite outcome was the time to the first disease-related event (death, reintervention, worsening of symptoms). Primary outcome measures were overall (diseasespecific) and disease-free survival. The overall identification rate of SLN in melanoma patients by dual labelling method was 98.5%. All patients with positive SLNB on frozen section underwent complete regional lymphadenectomy. Using multivariable analysis Breslow thickness of the lesion (p=0.00004, HR 4.03 on logarithmic scale) was identified as the strongest independent predictor of the disease-free survival (DFS) and male gender was significant predictor of DFS. An increase in tumor thickness was associated with significantly higher risk of an event. Neither SLN positivity nor initial S-100 level proved to be significant predictors of the event at the 0.05 level of probability. Multidisciplinary approach represents the gold standard of care for melanoma patients and surgery remains the best option for most localized cases. Although the usefulness of SLNB procedure has been questioned, it provides an excellent staging method, moreover, it can identify high-risk patients. The routine use of completion lymphadenectomy after a positive SLNB is still controversial. It is not clear whether CLND following a positive SLN biopsy improves survival but it could provide regional disease control.