Background: Preoperative planning of patients diagnosed with pancreatic head cancer is difficult and requires specific expertise. This pilot study assesses the added value of three-dimensional (3D) patient models and computer-aided detection (CAD) algorithms in determining the resectability of pancreatic head tumors. Methods: This study included 14 hepatopancreatobiliary experts from eight hospitals. The participants assessed three radiologically resectable and three radiologically borderline resectable cases in a simulated setting via crossover design. Groups were divided in controls (using a CT scan), a 3D group (using a CT scan and 3D models), and a CAD group (using a CT scan, 3D and CAD). For the perceived fulfillment of preoperative needs, the quality and confidence of clinical decision-making were evaluated. Results: A higher perceived ability to determine degrees and the length of tumor–vessel contact was reported in the CAD group compared to controls (p = 0.022 and p = 0.003, respectively). Lower degrees of tumor–vessel contact were predicted for radiologically borderline resectable tumors in the CAD group compared to controls (p = 0.037). Higher confidence levels were observed in predicting the need for vascular resection in the 3D group compared to controls (p = 0.033) for all cases combined. Conclusions: “CAD (including 3D) improved experts’ perceived ability to accurately assess vessel involvement and supports the development of evolving techniques that may enhance the diagnosis and treatment of pancreatic cancer”.

BACKGROUND: The aim of the present study was to assess the role of the referral pattern and the timing of the surgical procedure on outcome after reconstructive surgery for bile duct injury (BDI). SUMMARY BACKGROUND DATA: BDI after laparoscopic cholecystectomy remains a major problem in current surgical practice. Controversy exists about the influence of previous interventions before referral and the timing of repair on outcome. METHODS: Of 500 patients referred to a tertiary center, 151 patients (30.2%) underwent reconstructive surgery for BDI. The influence of referral pattern was analyzed by defining patients as primary and secondary referred patients. The influence of timing of repair was investigated by categorizing 3 groups of patients: A, acute repair; B, delayed repair; and C, late repair. RESULTS: Hospital mortality was zero. Perioperative complications occurred in 29 patients (19.2%): in 26.4% in secondary referred patients and 7.9% in primary referred patients (P = 0.04). Perioperative complications occurred in group A in 33.3%, in group B in 15.6%, and in group C in 22.5% (P = 0.22). Postoperative strictures occurred significantly more often in patients operated in the acute phase (P < 0.01) and in secondary referred patients (P = 0.03). A multivariate analysis identified 3 independent negative predictive factors for outcome: extended injury in the biliary tree (odds ratio = 3.70; confidence interval, 1.32-10.34), secondary referral (odds ratio = 4.35; confidence interval, 1.12-16.76), and repair in the acute phase after injury (odds ratio = 5.44; confidence interval, 1.2-24.43). CONCLUSIONS: Reconstructive surgery for the treatment of BDI is associated with acceptable morbidity and no mortality. Extended injury to the bile duct, referral to a tertiary center after therapeutic interventions, and acute repair are independent negative predictors on outcome after reconstructive surgery for BDI.