An international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected ⩽12months and >12months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

Background Anastomotic leakage of pancreaticojejunostomy (PJ) remains the single most important source of morbidity after pancreaticoduodenectomy (PD). The primary aim of this randomized clinical trial comparing PG with PJ after PD was to test the hypothesis that invaginated PG would result in a lower rate and severity of pancreatic fistula. Methods Patients undergoing PD were randomized to receive either a duct‐to‐duct PJ or a double‐layer invaginated PG. The primary endpoint was the rate of pancreatic fistula, using the definition of the International Study Group on Pancreatic Fistula. Secondary endpoints were the evaluation of severe abdominal complications (Clavien–Dindo grade IIIa or above), endocrine and exocrine function. Results Of 123 patients randomized, 58 underwent PJ and 65 had PG. The incidence of pancreatic fistula was significantly higher following PJ than for PG (20 of 58 versus 10 of 65 respectively; P = 0·014), as was the severity of pancreatic fistula (grade A: 2 versus 5 per cent; grade B–C: 33 versus 11 per cent; P = 0·006). The hospital readmission rate for complications was significantly lower after PG (6 versus 24 per cent; P = 0·005), weight loss was lower (P = 0·025) and exocrine function better (P = 0·022). Conclusion The rate and severity of pancreatic fistula was significantly lower with this PG technique compared with that following PJ. Registration number: ISRCTN58328599 (http://www.controlled-trials.com).

Process variability is becoming a major challenge in CMOS design of general and embedded SRAMs in particular due to continuous device scaling. The main problems are the increased static power and reduced operating margins, robustness and reliability. A common way to reduce the static power consumption of an SRAM memory array is to decrease its supply voltage when in memory retention mode. However, this leads to a further reduction in memory robustness. The most common tool for statistical analysis of circuits under process variability is standard Monte Carlo simulation which has been proven to be too expensive when applied on an ultra dense SRAM. In this paper a statistical robustness analysis method is proposed based on decoupling statistical integration from robustness region determination in the parameter domain. The robustness is estimated with a ~ 556X speed up relation to Monte Carlo and an error of ~ 1%.

Reducing leakage in memories is critical to reduce static power consumption in nanometric technologies. A wide-spread technique for reducing the leakage consists of lowering the supply voltage on the SRAM module. The paper investigates the effect of lowering the supply voltage on the robustness of a 6T SRAM cell, both in saturation and sub-threshold regimes. The static noise margin (SNM) is evaluated analytically and compared with HSPICE simulations for 130 nm, 90 nm and 65 nm Berkeley predictive technology models (BPTM) [9]. In addition, the impact of process variation is considered.