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Need for pancreatoduodenectomy or total pancreatectomy for retroperitoneal sarcoma is rare. In most cases, these procedures are determined by locally advanced neoplasm. The author report successful multivisceral resection in a patient with retroperitoneal sarcoma complicated by internal fistulae with duodenum and colon.

Mucinous cystadenoma is a cystic tumor of the pancreas absolutely requiring surgical intervention. The authors report successful surgical treatment of a patient with mucinous pancreatic cystadenoma complicated by severe intestinal bleeding.

Objective: To evaluate the early outcomes of radical surgical treatment of patients with resectable periampullary tumors and previous acute pancreatitis (AP)., Material and Methods: A retrospective analysis included 9 patients. AP was diagnosed in all patients at different times of preoperative period (post-manipulative AP in 7 cases, alcoholic AP in 2 cases). Pancreaticoduodenectomy was performed in 5 patients, total pancreatectomy (TP) - in 4 patients., Results: Severe postoperative complications occurred in 3 patients after pancreaticoduodenectomy. There were no complications after TP. All complications after pancreaticoduodenectomy were associated with a pancreatic stump that required urgent surgical interventions. Three patients died from surgical complications. All postoperative deaths were observed after pancreaticoduodenectomy., Conclusion: TP may be a safer surgical option compared to pancreaticoduodenectomy in patients with resectable periampiullary tumors and preoperative AP.

Specific complications is an «Achilles heel» of pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) is the most common specific complication. POPF prediction is an actual problem in pancreatic surgery. Analysis of statistically significant scoring systems to predict POPF is a modern trend in perioperative planning. Several prognostic scales (FRS, a-FRS, ua-FRS, Modified Fistula Risk Score) are recommended for clinical practice.

Background: Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs., Methods: Patients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses., Results: sNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2-3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11-20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively., Conclusions: In sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2-3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Non-functional pancreatic neuroendocrine tumors (NF-PNET) are rare neoplasms being increasingly diagnosed. Surgical treatment or expectant management are both suggested for small NF-PNETs. The aim of this study was to evaluate the outcome of surveillance strategy for small NF-PNETs., Methods: A systematic search was performed up to March 2016 in MEDLINE, EMBASE and the Cochrane Library according to the PRISMA guidelines. Data was pooled using the random-effects model., Results: Nine articles including 344 patients with sporadic and 64 patients with MEN1 related NF-PNET were selected. Tumor growth was observed in 22% and 52%, development of metastases were reported on 0% and 9%, and rate of secondary surgical resection was 12% and 25% in patients with sporadic or MEN1 related NF-PNETs, respectively. All metastases (1 distant, 4 nodal) were reported by a single study in patients with MEN1. Reason for secondary surgery was tumor growth in half of patients undergoing surgery., Discussion: Expectant management of small asymptomatic, sporadic, NF-PNETs could be a reasonable option in highly selected patients. However, the level of evidence is low and longer follow-up is needed to identify patients could benefit from upfront surgery instead of expectant treatment., (Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

To analyze the early results of radical surgery for gastric cancer in patients > 75 years. In the period between Jan. 2013 and June 2015 there were 25 radical operations in elderly (≥ 75 years) patients with gastric cancer. The following outcomes are presented: bloodloss, duration of surgery, mortality and morbidiy according to Dindo-Clavien classification, length of stay. There were 12 total and 13 distal gastrectomies, including 8 laparoscopic procedures (2 - total laparoscopic gastrectomies), all with D2 lymph node dissection. Mean bloodloss constituted 50±64 ml (0-300 ml), mean duration of surgery 220±70 min (140-360 min). There was no in-hospital mortality, but one patient died 2 weeks after discharge because of an unclear intraluminal bleeding. Mild complications (Dindo-Clavien I-II) were found in 6 patients, severe in 11 patients. In 6 patients repeated laparotomies were necessary. Mean length-of-stay constituted 13±17 (5-63) days. Radical gastric cancer surgery in the elderly patients is feasible. A prerequisite is a thorough pre-operative examination. This type of surgery shall be practiced in highly specialized centers after detailled control of patients’ comorbidity.