Pancreatic fistula is still one of the most serious and potential complications after D2-D3 distal and total gastrectomy (4% to 6%). Despite their importance, pancreatic fistulas still have not been uniformly defined. Amylase concentration of the drainage fluid after surgery for gastric cancer can be considered as a predictive factor of the presence of pancreatic fistula. From January 2009 to April 2013, 53 patients underwent surgery for gastric cancer. Amylase concentration in the drainage fluid was measured on the first postoperative day and if it was ≥1,000 UI, it was measured again on the third postoperative day. Pancreatic fistula occurred in four cases (7.5%). Pancreatic fistulas were classified using the International Study Group on Pancreatic Fistula (ISGPF) criteria into different grades of severity. Two fistulas were Grade A, one was Grade B, and one was Grade C. Management of drainage tubes is still crucial after gastrectomy, not only for the likelihood of anastomotic leaks but also the eventual diagnosis and management of pancreatic fistula. High amylase drainage content and then the presence of the pancreatic fistula may be due to several causes: the operation itself when it includes splenectomy or pancreatic tail-splenectomy, the extended lymphadenectomy but even the ‘gently and softly’ pancreatic manipulation, according literature, may be a risk factor. The authors assessed amylase concentration in the drainage fluid collected from the left subphrenic cavity on POD1 and POD3 in 53 patients who had undergone curative gastrectomy for cancer and concluded that amylase drainage content >3 times the serum amylase was a useful predictive risk factor for pancreatic fistula. Our work is an interim analysis and the aim of this study is to increase the accrual of the number of patients to have a significant number. For this reason, a protocol for a multicenter trial will be designed to verify whether the systematic measurement of amylase in drain fluid is better than abdominal ultrasound for the detection of pancreatic fistula after gastric cancer surgery.

Background: Right hemicolectomy remains the standard surgical treatment for right colon diseases. This study evaluates robotic versus laparoscopic approaches to determine optimal, minimally invasive strategies, balancing technical efficacy with healthcare economics. Materials and Methods: This retrospective study evaluates robotic versus laparoscopic approaches using data from 46 studies (2003–2025) involving 36,868 patients (6,312 robotic, 30,547 laparoscopic). Primary outcomes assessed were lymph node yield, operative time, and hospital stay; secondary outcomes included blood loss, conversion rates, infections, readmissions, and costs. Results: Concerning robotic surgery, lymph node harvest was higher (MD 1.34 for CME; MD 1.27 for non-CME). Laparoscopy showed shorter operative times (MD 25.73 for CME; MD 42.45 for non-CME). Hospital stays showed no significant difference. Robotics demonstrated lower blood loss in non-CME cases (MD -0.38). Conversion rates favored robotics (1% vs. 10% for CME; 4% vs. 8% for non-CME). No significant differences were found in wound infections or non-CME readmissions, though robotics showed lower CME readmission costs (MD 5.34). There were several study-acknowledged limitations, including surgeon preference bias, protocol variability, learning curves, and evolving techniques over the 22-year period. Cost analyses considered both direct surgical expenses and postoperative care. Conclusions: While robotics offers advantages in oncological resection and procedural stability, laparoscopy maintains efficiency benefits. These findings contribute to ongoing discussions about optimal, minimally invasive approaches for right colon pathologies, balancing technical efficacy with healthcare economics. By comparing surgical techniques, surgeon expertise, patient characteristics, and healthcare costs across multiple institutions, this study seeks to provide meaningful insights for surgical decision-making and further standardization.

Background and Objectives: Traumatic hemorrhage remains the leading cause of preventable death following major injury, with most hemorrhage-related fatalities occurring within the first hours after trauma. During this early phase, trauma-induced coagulopathy (TIC) frequently develops as an independent pathophysiological response, affecting up to one-third of severely injured patients and being strongly associated with increased morbidity and mortality. Over the past two decades, TIC has been recognized as a complex endogenous process rather than a simple consequence of dilution, hypothermia, or acidosis, prompting a paradigm shift in early trauma resuscitation. Materials and Methods: This narrative review analyzes the current literature on the pathophysiology of TIC and the evolution of hemostatic resuscitation strategies. Key topics include the mechanisms underlying early coagulopathy, its clinical impact, and the evidence supporting contemporary therapeutic approaches. Published data on balanced transfusion strategies, whole blood transfusion, fibrinogen replacement, cryoprecipitate, prothrombin complex concentrates, tranexamic acid and viscoelastic-guided resuscitation were reviewed, along with relevant international guidelines. Results: Emerging evidence supports early, balanced, and targeted hemostatic resuscitation to mitigate the effects of TIC and improve outcomes in bleeding trauma patients. Balanced transfusion ratios, prompt correction of fibrinogen deficiency, early antifibrinolytic therapy and selective use of coagulation factor concentrates have been associated with reduced transfusion requirements and improved survival. Viscoelastic testing enables rapid, individualized assessment of coagulation abnormalities, although its availability and implementation remain inconsistent across trauma systems. Conclusions: Early recognition and aggressive, structured management of trauma-induced coagulopathy are essential to reduce preventable deaths from traumatic hemorrhage. While advances in hemostatic resuscitation have improved outcomes, significant challenges remain in standardizing treatment protocols and expanding access to viscoelastic diagnostics. Ongoing research and system-level optimization are needed to further refine and disseminate evidence-based strategies for the management of TIC.