Laparoscopic distal pancreatectomy is a minimally invasive approach for the surgical treatment of neoplasms in the distal pancreas. This study aimed to compare this approach to the open procedure. A retrospective analysis of a prospectively maintained database of 400 pancreatectomies was performed. The laparoscopic distal pancreatectomy group (LDP) was compared to the open distal pancreatectomy group (ODP). A propensity score matching analysis (PSM) was performed. From 2016 to 2023, 108 distal pancreatectomies were carried out, 19 (17.6%) laparoscopically and 89 (82.4%) openly. The conversion rate was 13.6%. The severe morbidity rates were 28.1% in the ODP group, 47.4% in the LDP group, and 15.8% in the ODP-PSM group. The difference between the latter two was statistically significant (p = 0.034) due to the high rate of Clavien–Dindo grade 3a complications (42.1% versus 10.5%, p = 0.042) in the LDP group. The 90-day mortality rates were 3.3% in the ODP group and 5.3% in the other two groups. The LDP group had a shorter duration of intravenous narcotic analgesia (5 versus 7 days, p = 0.041). There was no difference in the R0 resection or postoperative pancreatic fistula rates. Our attention should be drawn to preventing postoperative complications because the oncological outcomes are already comparable with those of the open procedure, and postoperative pain management is promising.

Background: Bile duct injury (BDI) during (laparoscopic) cholecystectomy has an incidence of up to 1.5%. This retrospective study aimed to report the outcomes of surgical repair of BDI due to these procedures at a tertiary referral center. Methods: A retrospective review of patients’ records was conducted. The BDI’s clinical presentations, Strasberg classification, surgical repairs, and outcomes were reported. Results: From 2003 to 2024, 47 BDIs were identified. In total, 34.0% were recognized intraoperatively. The BDI types included Strasberg types B (2, 4.3%), C (5, 10.6%), D (11, 23.4%), E1 (4, 8.5%), E2 (12, 25.5%), E3 (5, 10.6%), E4 (3, 6.4%), and E5 (5, 10.6%). The T-tube group included 6 (12.8%) patients, the primary repair and T-tube group included 10 (21.3%) patients, and the Biliodigestive anastomosis group included 31 (65.9%) patients. The overall morbidity rate was 40.4%, the major morbidity rate was 21.3%, and the mortality rate was 4.3%. Grade A patency was achieved in 95.6% of patients. In the Biliodigestive anastomosis group, the actuarial 1-, 5- and 10-year grade A patency rates were 77.0%, 70.0%, and 70.0%, respectively. Conclusion: The rate of BDI remains stable. The outcomes of repairs in terms of complications and patency rates are comparable to those in other reports.

Background and Objectives: The issue of a missing variable precludes the external validation of many prognostic models. For example, the Liverpool score predicts the survival of patients undergoing surgical therapy for colorectal liver metastases, but it includes the neutrophil–lymphocyte ratio, which cannot be measured retrospectively. Materials and Methods: We aimed to find the most appropriate replacement for the neutrophil–lymphocyte ratio. Survival analysis was performed on data representing 632 liver resections for colorectal liver metastases from 2000 to 2020. Variables associated with the Liverpool score, C-reactive protein, albumins, and fibrinogen were ranked. The rankings were performed in four ways: The first two were based on the Kaplan-Meier method (log-rank statistics and the definite integral $I_S$ between two survival curves). The next method of ranking was based on univariate and multivariate Cox regression analyses. Results: The ranks were as follows: the radicality of liver resection (rank 1), lymph node infiltration of primary colorectal cancer (rank 2), elevated C-reactive protein (rank 3), the American Society of Anesthesiologists Classification grade (rank 4), the right-sidedness of primary colorectal cancer (rank 5), the multiplicity of colorectal liver metastases (rank 6), the size of colorectal liver metastases (rank 7), albumins (rank 8), and fibrinogen (rank 9). Conclusions: The ranking methodologies resulted in almost the same ranking order of the variables. Elevated C-reactive protein was ranked highly and can be considered a relevant replacement for the neutrophil–lymphocyte ratio in the Liverpool score. These methods are suitable for ranking variables in similar models for medical research.