Introduction: Pancreatic cancer is the third leading cause of cancer death after lung and colorectal cancer and its diagnosis is often difficult to make in the early stages. Investigations such as echoendoscopy are an asset in the diagnostic arsenal of the medical-surgical team. Method: We propose for presentation a case of a patient who, at reevaluation one year after cholecystectomy, presents a cephalopancreatic tumor so he was proposed for duodenopancreatectomy following the decision of an interdisciplinary medical-surgical team. Results: A 69-year-old patient with a history of mediocoledocian stenosis for which biliary and pancreatic stents were fitted endoscopically, presents at the hospital with clinical signs suggestive of acute cholecystitis. Surgery is decided and an open cholecystectomy is performed for plastronated pyocholecystitis. Intraoperatively, it was observed an accentuated pericephalopancreatic inflammation, but it is not considered to be with a tumoral substrate. Subsequently, at approximately 1 year, CT scan is performed and suggests a cephalopancreatic tumor, so an echoendoscopy with biopsy was performed and the histopathological result was high-grade intraepithelial ductal pancreatic neoplasia. Following the multidisciplinary consultation within the tumor board, the patient is proposed for duodenopancreatectomy. Conclusion: Pancreatic neoplasm, although an extremely difficult pathology from the point of view of diagnosis and treatment, can and must be managed in multidisciplinary medical-surgical teams both in terms of medical expertise and investigations. Such therapeutic decisions are presented within specialized tumor boards, the oncological surgical treatment being an ample one.

Introduction: Pancreatic surgery is a complex surgery with still high morbidity and mortality and involves multidisciplinary team, specialized centers and standardization methods to reduce these rates. The National Register of Pancreatic Surgery is a useful tool in its standardization. Methods: The National Register of Pancreatic Surgery is the largest national database containing information on patients who have undergone total duodenopancreatectomy, cephalic duodenopancreatectomy or body-caudal pancreatectomy, for benign or malignant pathology, since October 1, 2016. Data are collected from over 7 centers and contain information about patient characteristics, pancreatic and associated pathology, surgical technique, complications and length of hospital stay. Results: For a young and growing team of HPB surgery, the National Pancreas Registry has been a useful tool in standardizing and developing this kind of surgery. Aspects like artery first approach, harvesting bilicultures, choosing the type of anastomosis according to the consistency of the pancreas have become standard, starting with January 2019, since our center participates in this register. Also, the offered landmarks helped us to transplant the experience in a new surgery center, along with the limitation of pancreatic surgery in St. John's Hospital Bucharest, due to the COVID-19 pandemic. Conclusions: The National Register of Pancreatic Surgery is a benchmark for the practice of this type of complex surgery and is an aid for its development in new centers at the beginning of the road.

Introduction: Although we live in the 21st century, hydatidosis is still a common disease Eastern Europe, especially in families with precarious economic and health status. Methods: We present a rare case of a voluminous hepatic hydatic cyst disseminated in both hepatic lobes with peritoneal hydatosis. After the anti-parasitic oral treatment, we performed a laparotomy with the excision of the cysts from segments 7-8, 4A and 4B, 5 and 2, partial omentectomy and cholecystectomy. The patient developed a large volume biliary fistula and although we performed an ERCP procedure with papilosfincterotomy and stenting with a significant decrease of the flow, the hospitalization period was still very long (8 weeks). Results: Patient never came for postoperative follow-up control and presented herself 5 months later, with a segment 7-8 hepatic abscess, that needed reoperation. Paradoxically, no biliary leak was developed after the second procedure, with smooth postoperative evolution. Conclusion: Managing such an advanced disease is challenging for the surgeon, not only technically, but also strategically, with a lot of costs for the hospital and treatments for all the postoperative complications. Difficult patients from rural areas are sometime difficult to manage, with fluctuant follow-up and an increase risc of complications.

Introduction: Ticagrelor is a very effective platelet aggregation inhibitor. Case report: A 72 years old man presented himself with intense right upper quadrant pain irradiated in the right shoulder. A CT scan was performed and a cyst in segments 6-7 was diagnosed, with 5mm free liquid around the liver. As the patient was stable and on Ticagrelor, we followed a conservative approach for the first 5 days. On the 6th day we performed an exploratory laparoscopy and a liver subcapsular hematoma of segment 6-7 was confirmed and evacuated via laparoscopy. Conclusion: Despite it's proven efficiency, Ticagrelor might have hemorrhagic side effects. We present the first case of liver spontaneous hematoma.

Background: We present the case of a 63 years old man who suffered a liver trauma seven years ago. Methods: He presents last year in our department with pelvic main due to giant pelvic hydatid cysts. Further abdominal Ct found a also a liver cyst in segment 8 with multiple adhesive between the cyst and the diaphragm. Results: A laparoscopic cyst fenestration (after inactivation) was performed and an open evacuation and partial excision of the pelvic cysts was performed. Conclusion: The peritoneal hydatidosis was most probably to a partial rupture many years ago of the liver hidatic cyst.

1.In autumn 2013 a new surgical oncology was created in Saint John Hospital Bucharest, with the main purpose to treat abdominal malignancies.

Background: Liver tumors can sometimes be a difficult diagnostic. Without specific imagistic findings and with negative tumor markers Methods: We present the case of a 63years old man who presented with a liver tumor in segment 2 with no specific findings on MRI and negative tumor markers. Colonoscopy and upper GI endoscopy were negative for any lesions. A laparoscopic liver resection was performed - segment 2-3 resection with a smooth postoperative course. The pathology result was a neuroendocrine tumor metastases. Results: Two month after the operation the gastroscopy was repeated and a small tumor was endoscopically excised from the gastric antrum. The pathology result was a gastrointestinal non-secretant neuroendocrine tumor. Conclusion: Due to an increase in the expertise in laparoscopic liver resections, a minimally invasive hepatectomy was the first step in this case.

Introduction: The difficulty to set a histopathological diagnosis in patients with cholangiocarcinoma is a challenge Methods: We present 7 cases of cholangiocarcinoma for witch was performed an excisional biopsy of ganglion 5. For this patients the histopathological diagnosis was not able to be performed neither by endoscopic of ecoendoscopic maneuver. 5 cases were made by laparoscopic approach and 2 by open procedure. Results: All the results from the biopsies were inconclusive and indicated inflammation Conclusions: Although the mini series was not on a large number of cases, the examination of ganglion 5 was not edifying in establishing the histopathological results in patients with cholangiocarcinoma and present metastasis.