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Colorectal neuroendocrine neoplasm (CRNEN), especially rectal tumours, are diagnosed with increased frequency due to the widespread use of colonoscopy, including screening examinations. It is important to constantly update and promote the principles of optimal diagnostics and treatment of these neoplasms. Based on the latest literature and arrangements made at the working meeting of the Polish Network of Neuroendocrine Tumours (June 2021), this paper includes updated and supplemented data and guidelines for the management of CRNEN originally published in Endokrynologia Polska 2017; 68: 250-260.

Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented here. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly - neuroendocrine carcinomas. Their symptoms may be untypical and their diagnosis may be delayed or accidental. Najczęściej pierwszą manifestacją ANEN jest jego ostre zapalenie. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of SINENs patients with distant metastases. In laboratory diagnostics the assessment of 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound examination, computed tomography, magnetic resonance imaging, colonoscopy and somatostatin receptor imaging. Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage dissemination with progression during SSAs treatment, with high expression of somatostatin receptors, radioisotope therapy should be considered first followed by targeted therapies - everolimus. After the exhaustion of the above available therapies, chemotherapy may be considered in selected cases. Recommendations for patient monitoring are also presented.

After another meeting of experts of the Polish Network of Neuroendocrine Tumours, updated recommendations for the management of patients with gastric and duodenal neuroendocrine neoplasms, including gastrinoma, have been issued. As before, the epidemiology, pathogenesis and clinical symptoms of these neoplasms have been discussed, as well as the principles of diagnostic procedures, including biochemical and histopathological diagnostics and tumour localisation, highlighting the changes introduced in the recommendations. Updated principles of therapeutic management have also been presented, including endoscopic and surgical treatment, and the options of pharmacological and radioisotope treatment. The importance of monitoring patients with gastric and duodenal NENs, including gastrinoma, has also been emphasised.

In this paper, we present the current guidelines for the diagnostics and management of pancreatic neuroendocrine neoplasms (PanNENs) developed by Polish experts providing care for these patients in everyday clinical practice. In oncological diagnostics, in addition to biochemical tests, molecular identification with the use of NETest liquid biopsy and circulating microRNAs is gaining importance. Both anatomical and functional examinations (including new radiopharmaceuticals) are used in imaging diagnostics. Histopathological diagnosis along with immunohistochemical examination still constitute the basis for therapeutic decisions. Whenever possible, surgical procedure is the treatment of choice. Pharmacological management including biotherapy, radioisotope therapy, targeted molecular therapy and chemotherapy are important methods of systemic therapy. Treatment of PanNENs requires a multidisciplinary team of specialists in the field of neuroendocrine neoplasms.

Introduction: Gastrointestinal neuroendocrine neoplasms arise from cells of the diffuse endocrine system (DES) located in the digestive tract. They are often diagnosed in an advanced stage, when distant metastases appear. Skin metastases of neuroendocrine tumors are extremely rare. Aim: The aim of the study was to collect and analyze cases of skin metastases of gastrointestinal neuroendocrine neoplasms. Materials and methods: A literature search across PubMed and Medline databases from 1969 up to 2021 was performed. We reviewed English literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following keywords were used: “neuroendocrine tumor”, “neuroendocrine neoplasm”, “neuroendocrine carcinoma”, “NET”, “NEN”, “skin and cutaneous metastases”, “lymph nodes”. The characteristics of patients, grading, tumor localization and other data that was found in publications were assessed. Case reports and case series were included. Results: The initial search strategy yielded 14 results in PubMed and 3 in the Medline database. We removed duplicates after we imported the citations with a citation manager. We found 17 publications concerning skin metastases of neuroendocrine neoplasms. The analysis of 18 cases concerned 13 NECs and 5 NETs. In most cases, the metastases are small, painless and located on the scalp or lower extremities. Skin metastases may be the first symptom of the disease. The pancreas is the most common primary tumor site. Conclusions: NEN metastases to the skin are often diagnosed with disseminated neoplastic process, which is associated with poor prognosis and high mortality. NET metastases to the skin may occur with an unknown primary site. Skin metastases of neuroendocrine tumors should be considered during the diagnosis of skin tumors.

Continuous progress in the diagnostics and treatment of neuroendocrine neoplasms (NENs), the emerging results of new clinical trials, and the new guidelines issued by medical societies have prompted experts from the Polish Network of Neuroendocrine Tumours to update the 2017 recommendations regarding the management of neuroendocrine neoplasms. This article presents the general recommendations for the management of NENs, resulting from the findings of the experts participating in the Fourth Round Table Conference, entitled "Polish Guidelines for the Diagnostics and Treatment of Neuroendocrine Neoplasms of the gastrointestinal tract, Żelechów, June 2021". Drawing from the extensive experience of centres treating these cancers, we hope that we have managed to formulate the optimal method of treating patients with NENs, applying the latest reports and achievements in the field of medicine, which can be effectively implemented in our country. The respective parts of this work present the approach to the management of: NENs of the stomach and duodenum (including gastrinoma), pancreas, small intestine, and appendix, as well as large intestine.

BACKGROUND Pancreatoduodenectomy is an extensive procedure with a very high risk of complications. Appropriate intraoperative fluid therapy is a subject of ongoing debate. The aim of this retrospective study was to analyze the relationship between selected preoperative parameters, intraoperative fluid therapy, and catecholamines administration during pancreatoduodenectomy. MATERIAL AND METHODS From 2011 through 2017, among pancreatoduodenectomies performed at a single university hospital, 192 patients met the inclusion criteria of the study: 105 (54.7%) males and 87 (45.3%) females with a mean age of 60.06 (±11.63) years. Correlations were assessed between sex, age, body mass index (BMI), selected comorbidities, surgery duration, American Society of Anesthesiologists (ASA) Physical Status (PS) scale, preoperative endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative catecholamine administration, intraoperative fluid supply, red blood cell (RBC) concentrate and fresh frozen plasma (FFP) supply, blood loss, and diuresis. RESULTS A need for catecholamines has been shown to be more frequent in smokers (P=0.01), patients with cardiovascular comorbidities (P=0.037), high ASA PS scores (P=0.003), and preoperative ERCP (P=0.011). The need for intraoperative transfusion of RBC concentrate was more frequent in smokers (P=0.005). Surgical time was significantly longer in males (P=0.014). Among females, liberal intraoperative fluid therapy (7.9 ml/kg/h) was more frequent in patients with thyroid comorbidities (P=0.003). CONCLUSIONS The findings of this retrospective study demonstrate the influence of comorbidities, ASA PS class, and catecholamine use on fluid therapy during pancreatoduodenectomy.

Bartosz Molasy,1,2 Patryk Zem&lstrok;a,1 S&lstrok;awomir Mrowiec,3 Ewa Grudzi&nacute;ska,3 Katarzyna Ku&sacute;nierz3 1Students’ Scientific Society of the Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland; 2Department of General Surgery, St Alexander Hospital, Kielce, Poland; 3Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, PolandCorrespondence: Ewa Grudzi&nacute;ska, Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland, Tel +48 32 7894252, Email ewa.grudzinska@sum.edu.plPurpose: Metastases of pancreatic neuroendocrine tumors (pNETs) can be found at the time of diagnosis in 20– 50% of cases. Small asymptomatic tumors may be left for observation; however, they can metastasize. The aim of the study was to evaluate risk factors for distant and lymph node metastases of pNETs.Patients and methods: One hundred and fourteen patients with postoperatively confirmed pNET were analyzed retrospectively in a single ENETS Center of Excellence. The relationship between location, size, differentiation of the tumor, and occurrence of lymph node and distant metastases was analyzed.Results: pNETs’ location was pancreatic head – 38 (33.3%), body or tail – 68 (59.7%), and 8 (7.0%) involved the entire organ. Fifty-six (49.1%) tumors were graded G1, 50 (43.9%) G2, and 8 (7.0%) G3. Seventy-two (63.2%) tumors were ≥ 2 cm in diameter, and 42 (36.8%) < 2 cm. Twenty-two (19.3%) patients had distant metastases and 47 (41.2%) had lymph node metastases. In ≥ 2 cm tumors distant and lymph node metastases were more frequent (p < 0.05). Distant metastases incidence was significantly higher in distally located tumors (p = 0.01) and in G2 and G3 tumors (p < 0.01). In 9.5% of < 2cm tumors, distant metastases were present at diagnosis.Conclusion: Distant metastases are more often found in larger, distally located pNETs grade G2 and G3, while a higher occurrence of lymph node metastases seems to be associated only with larger tumor size. A considerable number of tumors < 2 cm in size have distant metastases already at the diagnosis, which might indicate the need for careful qualification of smaller lesions for observation.Keywords: pancreas, neuroendocrine tumor, lymphatic metastasis, lymph nodes, pancreatic surgery

Opisujemy przypadek pacjentki z rozpoznaniem raka neuroendokrynnego trzustki z przerzutem do skory. Pierwotnie, w badaniu fizykalnym stwierdzono jedynie powiekszone wezly chlonne pachwinowe prawe. Pomimo wykonania wielu badan obrazowych i czynnościowych oraz przeprowadzenia licznych konsultacji specjalistycznych nie zlokalizowano ogniska pierwotnego. W wykonanych, w przebiegu choroby, kontrolnych badaniach obrazowych uwidoczniono ognisko pierwotne w trzustce. Pacjentke zakwalifikowano do zabiegu resekcyjnego. Jednak przed planowanym zabiegiem pacjentka zauwazyla szybkorosnącego guza przedramienia, ktory w badaniu histopatologicznym okazal sie przerzutem raka neuroendokrynnego do skory. Z powodu znacznej progresji guza trzustki odstąpiono od zabiegu operacyjnego. Pacjentke skierowano do paliatywnego leczenia onkologicznego, ktorego ze wzgledu na gwaltownie pogarszający sie stan ogolny nie otrzymala. Zmarla po 6 miesiącach.

Most pancreatic neuroendocrine tumors (PNETs) are indolent, while pancreatic ductal adenocarcinomas (PDACs) are particularly aggressive. To elucidate the basis for this difference and to establish the biomarkers, by using the deep sequencing, we analyzed somatic variants across coding regions of 409 cancer genes and measured mRNA/miRNA expression in nine PNETs, eight PDACs, and four intestinal neuroendocrine tumors (INETs). There were 153 unique somatic variants considered pathogenic or likely pathogenic, found in 50, 57, and 24 genes in PDACs, PNETs, and INETs, respectively. Ten and 11 genes contained a pathogenic mutation in at least one sample of all tumor types and in PDACs and PNETs, respectively, while 28, 34, and 11 genes were found to be mutated exclusively in PDACs, PNETs, and INETs, respectively. The mRNA and miRNA transcriptomes of PDACs and NETs were distinct: from 54 to 1659 differentially expressed mRNAs and from 117 to 250 differentially expressed miRNAs exhibited high discrimination ability and resulted in models with an area under the receiver operating characteristics curve (AUC-ROC) &gt, 0.9 for both miRNA and mRNA. Given the miRNAs high stability, we proposed exploring that class of RNA as new pancreatic tumor biomarkers.

This paper presents the updated Polish Neuroendocrine Tumour Network expert panel recommendations on the management of neuroendocrine neoplasms (NENs) of the stomach and duodenum, including gastrinoma. The recommendations discuss the epidemiology, pathogenesis, and clinical presentation of these tumours as well as their diagnosis, including biochemical, histopathological, and localisation diagnoses. The principles of treatment are discussed, including endoscopic, surgical, pharmacological, and radionuclide treatments. Finally, there are also recommendations on patient monitoring.

This study presents the revised Polish guidelines regarding the management of patients suffering from neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common location for these neoplasms. Most are well differentiated and slow growing. Their symptoms may be atypical, which can result in delayed or accidental diagnosis. Appendicitis is usually the first manifestation of NEN in this location. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of patients suffering from small intestinal NENs with distant metastases. The main cause of death in patients with carcinoid syndrome is carcinoid heart disease. The most useful laboratory test is the determination of chromogranin A, while concentration of 5-hydroxyindoleacetic acid is helpful in the diagnostics of carcinoid syndrome. For visualisation, ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, double-balloon enteroscopy, and somatostatin receptor scintigraphy may be used. A detailed his-tological report is crucial for the proper diagnostics and therapy of NENs of the small intestine and appendix. The treatment of choice is surgical management, either radical or palliative. The pharmacological treatment of the hormonally active and non-active small intestinal NENs as well as NENs of the appendix is based on long-acting somatostatin analogues. In patients with generalised NENs of the small intestine in progress during the SSA treatment, with good expression of somatostatin receptors, the first-line treatment should be radio-isotope therapy, while targeted therapies, such as everolimus, should be considered afterwards. When the above therapies are exhausted, in certain cases chemotherapy may be considered.

Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer-tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358-368.

The aim of this work is to investigate the optimal therapeutic sequence of resectable pancreatic cancer - primary surgery with adjuvant therapy or neoadjuvant followed by resection. Application of the neoadjuvant approach in routine treatment of pancreatic cancer is rapidly growing every year, despite the lack of final results from randomized trials. Recent advancements in the adjuvant therapy, due to the more effective chemotherapy regimens, favor the upfront surgery strategy. On the other hand, theoretical background and metaanalyses favor the neoadjuvant strategy. Currently, primary resection with adjuvant chemotherapy remains the standard approach in resectable pancreatic cancer, but the first recommendations considering the neoadjuvant approach as an option seem to arise among the scientific societies with a global impact. Preliminary results of Prodige 24 study and PREOPANC-1 trial demonstrates that both options are worth further evaluation in clinical trials. Their results should soon provide more answers to this important clinical questions.

The presented recommendations concern the current management of acute pancreatitis. The recommendations relate to the diagnostics and treatment of early and late phases of acute pancreatitis and complications of the disease taking into consideration surgical and endoscopic methods. All the recommendations were subjected to voting by the members of the Working Group of the Polish Pancreatic Club, who evaluated them every single time on a five-point scale, where A means full acceptance, B means acceptance with a certain reservation, C means acceptance with a serious reservation, D means rejection with a certain reservation and E means full rejection. The results of the vote, together with commentary, are provided for each recommendation.

Sutures are the most versatile materials used in surgery. Despite recent technological advances and availability of novel materials such as tissue cements, it appears that surgical sutures will continue to be used for many years to come. The objective of this study was to provide an overview of the most common absorbable sutures used in general surgery. The appropriate suture choice for a particular procedure is of key importance for the success of that procedure.

Introduction We undertook a comparative survey of gastric emptying (GE) kinetics after two variants of bypass surgery for upper bowel obstruction. Material & methods In 10 dogs with experimental upper bowel obstruction, five were randomized to obtain gastrojejunal anastomosis (GA), and the other five received Roux-en-Y duodenojejunal anastomosis (DA). Duplicate scintigraphic measurements of GE of a solid meal were accomplished in every animal before surgery and during the early (2–3 weeks), medium (3 months), and late (6 months) post-operative period. The GE curves were fitted with a power-exponential function to derive the GE half time T½, and the curve shape parameter S. Results Early after surgery T½ slightly decreased by -18±21 min in the DA group and lengthened by 91±37 min in the GA group (p = 0.042). In both groups an increase in the S parameter was found then. In either group T½ gradually declined towards the basal value during the medium and late post-operative period. On the other hand, net differences relative to the basal situation in the S values appeared to be positive in the GA group (0.32±0.11 at 3 months; 0.64±0.19 at six months), and negative in the DA group (-0.30±0.09 at 3 months; -0.01±0.20 at six months). Hence a statistically significant contrast was found between those differences: p = 0.0022 at 3 months, and p = 0.045 at six months after the surgery. Conclusion Roux-en-Y duodenojejunal anastomosis appears to be superior to the classical gastrojejunal anastomosis while restoring patency of the gastrointestinal passage in the case of upper bowel obstruction.

This article presents updated diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine tumours (PNEN), proposed by the Polish Network of Neuroendocrine Tumours. The guidelines contain new data received in the years 2013-2016, which confirm previous recommendations, and have led to modification of previous guidelines or have resulted in the formulation of new guidelines. Biochemical and imaging (anatomical and functional) tests are of great importance in diagnostics, as well as histopathological diagnosis to determine the management of PNEN patients, but they must be confirmed by an immunohistochemical examination. PNEN therapy requires collaboration among the members a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment in many cases. Further therapy requires a multidirectional procedure; therefore, the rules of biotherapy, peptide receptor radionuclide therapy, molecular targeted therapy, and chemotherapy are discussed.

Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer-tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358-368.

Progress in the diagnostics and therapy of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN), the published results of new randomised clinical trials, and the new guidelines issued by the European Neuroendocrine Tumour Society (ENETS) have led the Polish Network of Neuroendocrine Tumours to update the 2013 guidelines regarding management of these neoplasms. We present the general recommendations for the management of NENs, developed by experts during the Third Round Table Conference - Diagnostics and therapy of gastro-entero-pancreatic neuroendocrine neoplasms: Polish recommendations in view of current European recommenda-tions, which took place in December 2016 in Żelechów near Warsaw. Drawing from the extensive experience of centres dealing with this type of neoplasms, we hope that we have managed to develop the optimal management system, applying the most recent achievements in the field of medicine, for these patients, and that it can be implemented effectively in Poland. These management guidelines have been arranged in the following order: gastric and duodenal NENs (including gastrinoma); pancreatic NENs; NENs of the small intestine and appendix, and colorectal NENs.

Progress in the diagnostics and therapy of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN), the published results of new randomised clinical trials, and the new guidelines issued by the European Neuroendocrine Tumour Society (ENETS) have led the Polish Network of Neuroendocrine Tumours to update the 2013 guidelines regarding management of these neoplasms. We present the general recommendations for the management of NENs, developed by experts during the Third Round Table Conference - Diagnostics and therapy of gastro-entero-pancreatic neuroendocrine neoplasms: Polish recommendations in view of current European recommenda-tions, which took place in December 2016 in Żelechow near Warsaw. Drawing from the extensive experience of centres dealing with this type of neoplasms, we hope that we have managed to develop the optimal management system, applying the most recent achievements in the field of medicine, for these patients, and that it can be implemented effectively in Poland. These management guidelines have been arranged in the following order: gastric and duodenal NENs (including gastrinoma); pancreatic NENs; NENs of the small intestine and appendix, and colorectal NENs.

This article presents updated diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine tumours (PNEN), proposed by the Polish Network of Neuroendocrine Tumours. The guidelines contain new data received in the years 2013-2016, which confirm previous recommendations, and have led to modification of previous guidelines or have resulted in the formulation of new guidelines. Biochemical and imaging (anatomical and functional) tests are of great importance in diagnostics, as well as histopathological diagnosis to determine the management of PNEN patients, but they must be confirmed by an immunohistochemical examination. PNEN therapy requires collaboration among the members a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment in many cases. Further therapy requires a multidirectional procedure; therefore, the rules of biotherapy, peptide receptor radionuclide therapy, molecular targeted therapy, and chemotherapy are discussed.

W niniejszej pracy przedstawiono uaktualnione zalecenia grupy ekspertow Polskiej Sieci Guzow Neuroendokrynnych dotyczące zasad postepowania w nowotworach neuroendokrynnych zolądka i dwunastnicy z uwzglednieniem gastrinoma . Omowiono epidemiologie, patogeneze i obraz kliniczny tych nowotworow. Przedstawiono zalecenia dotyczące zasad postepowania diagnostycznego, z uwzglednieniem diagnostyki biochemicznej, histopatologicznej oraz lokalizacyjnej. Uwzgledniono takze zasady postepowania terapeutycznego, w tym leczenie endoskopowe i chirurgiczne, oraz omowiono mozliwości leczenia farmakologicznego i radioizotopowego. Przedstawiono takze zalecenia odnośnie monitorowania chorych z NEN zolądka, dwunastnicy z uwzglednieniem gastrinoma .

Nowotwory neuroendokrynne (NENs) jelita grubego stanowią 20% wszystkich nowotworow neuroendokrynnych. Najczestszą ich lokalizacją jest odbytnica. Nowotwory neuroendokrynne jelita grubego są wykrywane coraz cześciej i liczba ta bedzie wzrastac z uwagi na powszechnośc wykonywania kolonoskopii, w tym badan przesiewowych oraz usuwanie wykrytych zmian. W pracy przedstawiono aktualne zalecenia dotyczące diagnostyki i terapii NEN jelita grubego, z uwzglednieniem diagnostyki biochemicznej, patomorfologicznej, nowych technik obrazowania oraz leczenia endoskopowego, chirurgicznego, farmakologicznego i radioizotopowego. Omowiono takze epidemiologie, charakterystyke kliniczną i monitorowanie leczenia.

RATIONALE Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms. PATIENT CONCERNS A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission. DIAGNOSIS Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid. INTERVENTIONS Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed. OUTCOMES The surgery led to recovery. Six months later, the patient reported good health and weight gain. LESSONS Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.

There is no universally accepted protocol for gross examination of pancreaticoduodenectomy specimens. Standardized protocol (SP), known as Leeds Pathology Protocol, was previously validated in pancreatic adenocarcinoma. In this study we aimed to assess usefulness of SP in a series of specimens with pancreatic, ampullary, and duodenal malignant neoplasms other than adenocarcinomas.SP was based on multi-colour inking and serial slicing of the specimens in a plane perpendicular to the duodenal axis. SP was used in a prospective cohort of 35 neoplasms of neuroendocrine, acinar, and solid-pseudopapillary lineage (SP cohort). Surgical margin status, primary tumour stage, and lymph node yield in SP group were compared with corresponding data of a historical cohort of 19 cases examined using non-standardized protocol (NSP). Samples examined in NSP and SP cohorts were comparable in terms of basic clinical characteristics, median tumour diameter, and distribution of histopathological diagnostic categories.In SP cohort we noticed: (1) higher rate of detection of tumour tissue at surgical margins, (2) more frequent peripancreatic fat tissue invasion, (3) higher percentage of perineural invasion, (4) larger number of lymph nodes retrieved from the specimen, in comparison to NSP group. Application of SP was associated with significantly higher number of tissue blocks taken for histology.SP can be successfully applied for macroscopical examination of pancreaticoduodenectomy specimens with malignant pancreatic, ampullary, and duodenal neoplasms other than adenocarcinomas. SP with proper microscopical diagnosis enables an appropriate schedule of patients with these neoplasms to adjuvant therapy and surveillance programmes.

The aim of the study was to present the first long-term results on the clinical use of compression anastomosis clips (CAC) in upper and lower gastrointestinal tract anastomoses.Material and methods. The study included 50 patients who underwent anastomosis of the upper (n = 32) or lower GI tract (n = 18) with the use of CAC. In the period of 6‑7 months after the surgery, patients underwent endoscopic examination and computed tomography evaluation of the anastomosis. Each anastomosis was evaluated macro and microscopically. The width of anastomoses was evaluated using a 4-point-scale for grading stenosis.Results. Of the 50 patients who underwent anastomosis with compression anastomosis clip, 28 (56%) patients reported to the follow-up examination within 190‑209 days of the execution of the anastomosis. Among the 22 patients who did not report to the study, 18 (36%) patients died within 91‑154 days from the execution of the anastomosis (mean 122 days), 4 (8%) patients were impossible to contact after discharge from hospital. Two mild stenoses (I0) were diagnosed; 1 of them was found in the gastroenterostomy and 1 in Braun enteroenterostomy. Microscopic changes were diagnosed in 4 anastomoses (3 gastroenterostomies, 1 Braun enteroenterostomy). Anastomoses were well-formed and wide, scars in the line of anastomoses were thin.Conclusions. During the period of 6 months after the anastomoses performed using CAC have been formed, they were evaluated as unobstructed and functioning properly; therefore, they can be safely performed within the upper and lower gastrointestinal tract.

Background. Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality. The ideal device to create anastomoses should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time. Objectives. The aim of this experimental study was to evaluate the safety and efficacy of a new compression anastomosis clip (CAC) for jejunojejunostomies and ileocolostomies by comparing CAC anastomoses with hand-sewn (HS) anastomoses in pigs in terms of healing, breaking strength and the time to create anastomoses. Material and Methods. The 11 pigs in the study underwent side-to-side CAC and HS jejunojejunostomies and ileocolostomies, for a total of 88 anastomoses. The pigs were sacrificed on postoperative day 5 (5 pigs) or 7 (6 pigs). Macroscopic, histopathological and breaking-strength examinations were performed. The time to create the anastomoses was recorded. Results. Neither group had anastomotic complications such as leakage or obstruction. Macroscopic examination showed no statistically significant differences between the groups. In the CAC group, the healing process was characterized by a lesser inflammatory reaction (p < 0.05) and very thin scar tissue at the anastomotic line (less collagen deposition and better epithelial regeneration), while the HS group had a much thicker anastomotic line. The breaking strength was significantly greater in the CAC group compared with the HS group (p < 0.05). The anastomosis time was shorter in the CAC group than in the HS group (p < 0.01). Conclusions. Anastomosis using a CAC appears to be safe and less time-consuming than HS; it was also characterized by a good healing process with little inflammatory reaction and a high breaking strength compared with HS anastomosis (Adv Clin Exp Med 2015, 24, 6, 000–000).

An increased interest in gastro-entero-pancreatic neuroendocrine neoplasms (GEP NENs) has recently been observed. These are rare neoplasms and their detection in recent years has improved. Over 50% of GEP NENs are carcinoids, and they are usually found incidentally during surgery in the small intestine and appendix and at diagnosis in distant metastases, mainly to the liver. There is a need for co-operation between specialists in various disciplines of medicine in order to work out the diagnostic and therapeutic guidelines. In this publication, we present general recommendations of the Polish Network of Neuroendocrine Tumours for the management of patients with GEP NENs, developed at the Consensus Conference which took place in Kamień Śląski in April 2013. Members of the guidelines working groups were assigned sections of the 2008 guidance to update. In the subsequent parts of this publication, we present the rules of diagnostic and therapeutic management of: - neuroendocrine neoplasms of the stomach and duodenum (including gastrinoma); - pancreatic neuroendocrine neoplasms; - neuroendocrine neoplasms of the small intestine and the appendix; - colorectal neuroendocrine neoplasms. The proposed recommendations by Polish and foreign experts representing different fields of medicine (endocrinology, gastroenterology, surgery, oncology, nuclear medicine and pathology) will be helpful in the diagnosis and treatment of GEP NENs patients.

We present revised diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine neoplasms (PNENs) proposed by the Polish Network of Neuroendocrine Tumours.These guidelines refer to biochemical (determination of specific and nonspecific neuroendocrine markers) and imaging diagnostics (EUS, CT, MR, and radioisotope examination with a 68Ga or 99Tc labelled somatostatin analogue).A histopathological diagnostic, which determines the further management of patients with PNENs, must be necessarily confirmed by immunohistochemical tests. PNENs therapy requires collaboration between a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment. Medical therapy requires a multidirectional procedure, and therefore the rules of biotherapy, peptide receptor radionuclide therapy, chemotherapy and molecular targeted therapy are discussed.

The compression anastomosis clip (CAC) is an elliptic shape double-ring device produced from nickel- titanium shape memory alloy. Until now the CAC works basing on the one-way shape memory effect. The aim of presenting studies was finding out the technology of two-way shape memory (TWSME) clips formation which should fulfil the requirements for clinical application. The clips were formed by wires of an alloy with 51.02 at. % Ni ± balance Ti. The best value of the TWME and uniform compression force of the clips was achieved by combining deformation, constrained aging and thermomechanical cycling.