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BACKGROUND: Data on the management of elderly patients with extensive colorectal liver metastases (CRLM) are scarce and conflicting. This study assesses differences in management and long-term oncological outcomes between older and younger patients with CRLM and a high Tumour Burden Score (TBS).; METHODS: International multicentre retrospective study on patients with CRLM and a category 3 TBS, submitted to liver resection. Patients were divided into two groups according to their age (younger and older than 75) and were compared using propensity score matching (PSM) analysis and multivariable regression models. Differences in management and oncological outcomes including recurrence-free survival (RFS) and overall survival (OS) were assessed.; RESULTS: The study included 386 patients, median follow-up was 48 months. The unmatched comparison revealed a higher ASA score (p=0.035), less synchronous CRLM (47% vs 68%, p=0.003), a lower median number of lesions (1 vs 3, p=0.004) and less perioperative chemotherapy (CTx) (66% vs 88%, p

Background There is still uncertainty regarding the role of perioperative chemotherapy (CTx) in patients with resectable colorectal liver metastases (CRLM), especially in those with a low-risk of recurrence. Methods Multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010–2015. Patients were divided into two groups according to whether they received perioperative CTx or not and were compared using propensity score matching (PSM) analysis. Then, they were stratified according to prognostic risk scores, including: Clinical Risk Score (CRS), Tumour Burden Score (TBS) and Genetic And Morphological Evaluation (GAME) score. Results The study included 967 patients with a median follow-up of 68 months. After PSM analysis, patients with perioperative CTx presented prolonged overall survival (OS) in comparison with the surgery alone group (82.8 vs 52.5 months, p = 0.017). On multivariable analysis perioperative CTx was an independent predictor of increased OS (HR 0.705, 95%CI 0.705–0.516, p = 0.029). The benefits of perioperative CTx on survival were confirmed in patients with CRS and TBS scores ≤2 (p = 0.022 and p = 0.020, respectively) and in patients with a GAME score ≤1 (p = 0.006). Conclusion Perioperative CTx demonstrated an increase in OS in patients with CRLM. Patients with a low-risk of recurrence seem to benefit from systemic treatment.

Infectious complications play a prominent role in postoperative outcome of pancreatoduodenectomy. The analysis of the microorganisms responsible for these complications has focused on bacteria, and there is little documentation regarding the role of fungi. We present a case series with 8 patients who underwent pancreatoduodenectomy with positive bile cultures for Candida spp., in order to analyse the postoperative outcome.

Abnormally positioned liver tissues are usually incidental findings diagnosed during imaging studies or surgical procedures. Most of the cases described are of congenital origin. We present a case corresponding to a 21-year-old young man with this entity.

Acute liver failure is an infrequent but serious complication of heat stroke damage. Management of these patients is mainly supportive, but in some cases liver transplantation may be the only chance for cure. We present the case of a young soldier who underwent emergency liver transplantation due to exertion heat stroke.

Nowadays endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique with a complication rate around 2.5% in expert hands, being the most frequent: acute pancreatitis, cholangitis, hemorrhage and perforation. An exceptional complication is subcapsular hepatic hematoma, first published in the literature in 2000, with few cases reported. Regarding the case published by Del Moral Martínez et al (Hepatic Hematoma after ERCP: presentation of two new cases. Rev Esp Enferm Dig 2017, Vol. 109, No. 6, pp. 470-473) we would like to contribute a reflection based on a recent clinical case in our center.

Introduction: Total hepatectomy with temporary porto caval shunt involves an anhepatic phase until liver transplantation. The severity of the patient's state is conditioned by the physiopathologic alterations occurred during the anhepatic phase and the availability or not of organs in the short term. Methods: We report the case of a male patient undergoing liver transplantation for liver failure caused by the hepatitis C virus (HCV). Until liver transplantation, the patient experienced an anhepatic phase of 22 hours secondary to acute vascular failure during surgery. The patient is alive at five follow-up years. Conclusions: Total hepatectomy with temporary portocaval anastomosis in combination with appropriate management of physiopathologic alterations at the Intensive Care Unit improve survival in severely-ill patients awaiting transplantation.

Ectopic or heterotopic pancreas is defined as the presence of pancreatic tissue in an anatomical place not related to the pancreas, being it most frequent locations the stomach and small bowel. Its finding in the gallbladder is exceptional. Since the first case was reported by Otschkin in 1916, about 30 cases have been described in literature. We report the case of a 43 years-old male patient who had an urgent laparoscopic cholecystectomy with the diagnosis of acute cholecystitis, which pathological study showed the existence of chronic cholecystitis with heterotopic pancreatic tissue in the gallbladder wall.

Cholangiocarcinoma is the second most common primary malignant tumor of the liver. Perihilar cholangiocarcinoma or Klatskin tumor represents more than 50% of all biliary tract cholangiocarcinomas. A wide range of risk factors have been identified among patients with Perihilar cholangiocarcinoma including advanced age, male gender, primary sclerosing cholangitis, choledochal cysts, cholelithiasis, cholecystitis, parasitic infection (Opisthorchis viverrini and Clonorchis sinensis), inflammatory bowel disease, alcoholic cirrhosis, nonalcoholic cirrhosis, chronic pancreatitis and metabolic syndrome. Various classifications have been used to describe the pathologic and radiologic appearance of cholangiocarcinoma. The three systems most commonly used to evaluate Perihilar cholangiocarcinoma are the Bismuth-Corlette (BC) system, the Memorial Sloan-Kettering Cancer Center and the TNM classification. The BC classification provides preoperative assessment of local spread. The Memorial Sloan-Kettering cancer center proposes a staging system according to three factors related to local tumor extent: the location and extent of bile duct involvement, the presence or absence of portal venous invasion, and the presence or absence of hepatic lobar atrophy. The TNM classification, besides the usual descriptors, tumor, node and metastases, provides additional information concerning the possibility for the residual tumor (R) and the histological grade (G). Recently, in 2011, a new consensus classification for the Perihilar cholangiocarcinoma had been published. The consensus was organised by the European Hepato-Pancreato-Biliary Association which identified the need for a new staging system for this type of tumors. The classification includes information concerning biliary or vascular (portal or arterial) involvement, lymph node status or metastases, but also other essential aspects related to the surgical risk, such as remnant hepatic volume or the possibility of underlying disease.

OBJETIVO: Comunicamos el caso de una paciente con un cáncer suprarrenal intervenido que presentó posteriormente recidivas locorregional y a distancia, enfatizando la importancia del tratamiento quirúrgico agresivo para lograr supervivencias a veces no esperadas a largo plazo. En la actualidad, representa el "gold standard" y todos los casos deben comunicarse para estimular a los distintos grupos a trabajar en esta línea. MÉTODO/RESULTADOS: se presenta el caso de una paciente de 29 años que consultó por dolor en flanco izquierdo, diagnosticándose en los estudios de imagen un tumor suprarrenal; fue intervenida, realizándose resección de un carcinoma suprarrenal izquierdo (Estadio II). Posteriormente presentó recidiva locorregional (en dos ocasiones) y a distancia (en hígado), siendo resecada la enfermedad en las tres ocasiones en su totalidad. En el momento actual, 7 años después del diagnóstico, está viva y libre de enfermedad. CONCLUSIÓN: la recidiva del cáncer suprarrenal se ha considerado letal a corto plazo desde el punto de vista pronóstico. Sin embargo, un abordaje quirúrgico agresivo de la enfermedad recurrente y metastásica puede prolongar de forma significativa la supervivencia del paciente y lograr, en ocasiones, "status" de libre de enfermedad varios años después del diagnóstico del tumor primario. OBJECTIVES: We report the case of a female patient with adrenal carcinoma who had undergone surgery and presented with local-regional and distant recurrences, emphasizing the importance of the aggressive surgical treatment to achieve long-term survival which is unexpected sometimes. Currently, it represents the gold standard and all cases should be reported to stimulate other groups to work in this line. METHODS/RESULTS: We report the case of a 29-yearold female patient who consulted for left flank pain, being diagnosed of an adrenal tumor by radiological tests; she underwent surgical excision of a left adrenal carcinoma (stage II). Later on she presented with localregional recurrences (2 times) and distant metastases (liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 years after diagnosis. CONCLUSIONS: Adrenal cancer recurrences have been considered lethal in the short-term. Nevertheless, an aggressive surgical approach of local recurrences and metastasic disease may significantly prolong patient’s survival and, sometimes, leave the patient disease free several years after the diagnosis of the primary tumor.

To analyze our results after the introduction of a fast-track (FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit.All patients (43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups: Control group (CG) from March 2004 until December 2006 with traditional perioperative cares (17 patients) and fast-track group (FTG) from January 2007 until March 2010 with FT program cares (26 patients). Primary endpoint was the influence of the program on the postoperative stay, the amount of re-admissions, morbidity and mortality. Secondarily we considered duration of surgery, use of drains, conversion to open surgery, intensive cares needs and transfusion.Both groups were homogeneous in age and sex. No differences in technique, time of surgery or conversion to open surgery were found, but more malignant diseases were operated in the FTG, and then transfusions were higher in FTG. Readmissions and morbidity were similar in both groups, without mortality. Postoperative stay was similar, with a median of 3 for CG vs 2.5 for FTG. However, the 80.8% of patients from FTG left the hospital within the first 3 d after surgery (58.8% for CG).The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions, which leads to a reduction of the stay and costs.