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cm3, MTV higher than 11.02 cm3 (OR 0.987, 95%CI 0.976-0.999, p0.029 and OR 0.246, 95%CI 0.089- 0.685, p 0.007, respectively) and elevated MPV (OR0.785, 95% CI 0,574-0.976, p0.042) were independent prognostic factors for predicting mortality.

TLG >46 g/ml.cm3 and MTV >11.02 cm3 in 18F-FDG PET/CT and elevated MPV in complete blood count are independent prognostic factors for predicting mortality in patients with unresectable or metastatic pancreatic cancer who are treated with chemotherapy.

Pancreatic cancer, Metabolic tumor volume, Total lesion glycolysis, Mean platelet volume.

Pancreatic cancer, Metabolic tumor volume, Total lesion glycolysis, Mean platelet volume.

Anastomotic leakage after rectal resection is a major complication which increases the rates of morbidity and mortality. A small number of patients with generalised peritonitis need radical surgical treatments. Stable patients with local peritonitis can be treated conservatively. The aim of this study is to evaluate the effects of transrectal vacuum treatment on the healing of low colorectal anastomotic leaks.

Medical records of fourteen patients managed conservatively with transrectal vacuum treatment for anastomotic leakage after rectal resection between September 2015 and September 2018, were retrospectively reviewed. Anastomotic leakage was documented and evaluated with computerised tomography and rectosigmoidoscopy.

10 of 14 patients had successful closure of the perianastomotic abscess cavity after a mean of 19 days of vacuum treatment. 2 patients in this group had stricture on the anastomotic site as a late complication which was successfully treated with repeated dilatations. 4 of 14 patients had eventually a permanent sigmoid colostomy.

Our results suggest that transrectal vacuum treatment can be safely used to all stable patients without generalised peritonitis in the management of low colorectal anastomotic leakages.

Anastomotic leakage, Rectosigmoidoscopy, Vacuum treatment, VAC.

Anastomotic leakage, Rectosigmoidoscopy, Vacuum treatment, VAC.Liver transplantation is considered to be the last hope of treatment for irreversible liver failure caused by different diffuse and/or space-occupying lesions of this organ. The strict limitation of the donor organs stipulates for development of alternative approaches for the solving this problem. The presented review of literature and our experience aims to discuss the modern aspects of management of different hepatic pathologies causing liver failure with the view of creation of the auxiliary, bioengineer-based functional tissues and/or organs and innovative surgical interventions allowing to conduct the operations in cases, which were up to date considered as inoperable. There are highlighted the last achievements of the experimental and translational studies performed in four University research centers of Georgia, which, on the one hand, provoke the specific professional interest, and on the other hand, require the international cooperation and collaboration for further progress and advances in this field of surgery. KEY WORDS Artificial liver, Bio-Artificial organs, Liver failure, Innovative surgery, Tissue engineering.

The aim of this study is to describe the incidence, imaging characteristics and pathological features of pancreatic incidentalomas. Moreover, surgical indications are discussed according to the nature and location of the neoplasms.

Pancreatic incidental lesions are more commonly diagnosed, due to the widespread of high quality cross sectional imaging. These lesions can be cystic or solid, benign, pre-malignant or already malignant and they cover a wide spectrum of histological diagnosis. Cystic lesions are more commonly benign or at least pre-malignant. Surgery should be reserved in case of unexpected changes in aspect during follow-up or for large cysts (>3 cm). LMB Among solid pancreatic incidentalomas, ductal adenocarcinoma is the most common diagnosis, followed by neuroendocrine tumors. Surgical treatment of pancreatic incidentaloma depends on the location of the tumor a Whipple's procedure should be performed for neoplasms of the head, while distal pancreatectomy is indicated for body and tail lesions. Pancreatic surgery is still delicate and burdened by serious complications. Both procedures can be performed with minimally-invasive technique which is connected to lower complications rate but, at present, they have shown no advantages in terms of mortality and oncologic outcomes.

Pancreatic incidentalomas are becoming more and more common but when and how to operate them is still subject of debate. Precise criteria about treatment strategy are still lacking and definite guidelines are needed to clarify the best approach.

Incidentaloma, Laparoscopy, Pancreatic tumors, Surgery.

Incidentaloma, Laparoscopy, Pancreatic tumors, Surgery.

The aim of this study was to evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) of colonic polyps larger than 20 mm.

Between March 2017 and July 2019, a gastro-entero endoscopist team resected 24 large colorectal polyps measuring 20-35 mm in diameter using the ESD technique. After the injection of a mixture of hydroxypropyl methylcellulose with dilute epinephrine and methylene blue into the submucosal layer, a circumferential incision was performed using an electrosurgical knife.

A total of 24 colorectal polyps (≥20 mm) from 20 patients were evaluated. The mean age of the patients was 60 years; 16 patients were men and 4 patients were women. The mean polyp size removed by colorectal ESD was 35.3 mm (range 20.0-70.1 mm), and all 24 polyps were larger than 2 cm (100%). There were no cases of delayed bleeding after the colorectal ESD nor were there any post-surgery complications.

This study demonstrates the efficacy and safety of carrying out ESD of large polyps. This is important because there is not a large body of literature on this subject in this specific population.

Colonic polyps, Endoscopic submucosal dissection, Gastrointestinal endoscopy.

Colonic polyps, Endoscopic submucosal dissection, Gastrointestinal endoscopy.

This study aims to evaluate the effects of low tidal volume and positive end expiratory pressure (PEEP) combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) ventilation on one lung ventilation (OLV) in patients with tuberculous destroyed lung (TDL).

Patients of two groups were all treated with volume controlled ventilation (VCV) on two-lung ventilation, and the tidal volume was set to 8 ml/kg according to standard body weight, breath rate was set to 10-14 times/min, inspiration and expiration ratio was set to 11.5. During OLV, VCV was used in group C, and the tidal volume was set to 8 ml/kg; PCV-VG was given to group P patients, and the tidal volume was set to 6 ml/kg, followed by PEEP at 7 cm H2O. Breath rate was set to 12-16 times/min, and inspiration and expiration ratio was set to 11.5 in both groups on OLV.

Pplat, Ppeak and intrapulmonary shunt (Qs/Qt) were lower at T2 and T3 in group P, when compared to group C (P<0.05). At T2, T3 and T4, the oxygenation index (OI) increased, Qs/Qt decreased and arterial carbon dioxide partial pressure (PaCO2) increased in group P (P<0.05). At T5, the concentration of IL-6, TNF-α and BNP decreased in group P.

Low tidal volume and PEEP combined with PCV-VG ventilation might be helpful for alleviating pulmonary injury in OLV, and reducing airway pressure and Qs/Qt during OLV in surgery.

Destroyed lung, Low tidal volume, Low tidal volume, Positive end-expiratory pressure, Pressure-controlled ventilation, One lung ventilation.

Destroyed lung, Low tidal volume, Low tidal volume, Positive end-expiratory pressure, Pressure-controlled ventilation, One lung ventilation.

Selective intraarterial radionuclide therapy (SIRT) with Yttrium-90 (Y-90) resin microspheres has been applied for hepatocellular carcinoma (HCC) lately. The aim of this study is to present our clinical experience of radiomicrosphere therapy in the treatment of unresectable HCC and determine the proper cases who could benefit from this therapy according to response results yielded by initial staging and control imaging modalities.

We administered 43 Y-90 microsphere therapy to 34 patients with unresectable HCC (twice in 9 patients). Patients with histopathologically confirmed HCC having a life expectancy of ≥3 months; Child A-B, Okuda stage 1-2 and BCLC stage A-B-C classifications were included in the study. The patients were divided into two groups Group A consisted of 29 patients who responded to Y-90 therapy (complete response, partial response and stable disease), Group B 5 of non-responders (progressive disease). Predefined parameters were evaluated for response to SIRT and compared between two groups.

We found a significant decrease in platelet and lymphocyte counts one month after therapy (p=0.02, p=0.01, respectively). On control imaging tests performed 3 months later, we observed complete response in 19% (n=6), partial response in 44% (n=15), stable disease in 25% (n=8) and progressive diease in 12% (n=5) of the patients. Mean overall survival (OS) was 19 (median value 14) months.

Y-90 microsphere therapy is a safe and effective treatment option for the patients with unresectable HCC without any serious side effect. Mean tumor dose delivery and lack of bilobar disease seem the best predictors for treatment success.

Selective intraarterial Radionuclide therapy, Yttrium-90, hepatocellular carcinoma.

Selective intraarterial Radionuclide therapy, Yttrium-90, hepatocellular carcinoma.In our study we examined 75 patients treated for rectal cancer in the period between 01/01/2011 and 31/12/2014. Out of these 75 patients, we considered those 36 staged through MRI. We then compared the TNM stage obtained through MRI with the one emerged from histological examination. The correlation between the two TNM stages was assessed considering all patients staged through MRI and dividing the cases according to the submission or not to a neoadjuvant treatment. Finally, we analyzed serum levels of tumor markers CEA, CA 19.9 and AFP, relating them with the final disease stage. Data analysis showed a statistically significant correlation in the T stages, especially in the population not subjected to neoadjuvant treatment. Instead, for N, we found no statistically significant correlation. Similarly, none of the tumor markers presented a statistically significant correlation with disease stage. However, according to the positivity of tumor markers, we associated the following score 0, (no positive marker)1 (only one marker positive) 2 (two markers positive) 3 (three markers positive). In presence of three markers positive, meaning the highest score, we found a statistically significant correlation with N + staging of the disease, obtained by postoperative pathologic examination. The conclusion is that MRI is certainly effective in T stage evaluation. Probably, for limph node involvement evaluation, more reliable parameters for establishing possible lymph node malignancy need to be found. The role of the tumor markers CEA, CA 19.9, AFP during preoperative evaluation of rectal tumors remains undefined. KEY WORDS MRI, Rectal cancer, Tumor markes, Tumor regression, T stage.