Corinna Slawinski

A cute pancreatitis is a surgical emergency that is common, poorly understood and carries a significant risk of death. It is an inflammatory process of the pancreas that is caused most commonly by gallstones or alcohol, and ranges from mild to severe disease (approximately 20% of cases). Acute pancreatitis is a common cause of emergency hospital admission, with an incidence of approximately 13–45 per 100 000 population per year (Yadav and Lowenfels, 2013). Severe acute pancreatitis is associated with a significant systemic inflammatory response, multiorgan failure and serious local complications. It is a challenging condition to treat, with substantial morbidity and mortality. The revised Atlanta classification provides clear definitions to classify acute pancreatitis, using easily identified clinical and radiological criteria (Banks et al, 2013). The most up-to-date guidance on the clinical management of acute pancreatitis was published in 2013 by the Working Party International Association of Pancreatology and the American Pancreatic Association (IAP/APA) (Working Group IAP/APA Acute Pancreatitis Guidelines, 2013) and should serve as a reference standard for current management. In the UK, a report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2016) identified that the management of acute pancreatitis was suboptimal in more than half the patients reviewed. This article is an up-to-date practical guide for the management of acute pancreatitis, consistent with the latest evidence-based guidelines, which builds upon the key findings and recommendations of the NCEPOD report.

Introduction Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastases (CLM). Patient selection is key, but there is wide variation in practice. Pre-operative chemotherapy can improve oncological outcomes, however chemotherapy-associated liver injury (CALI) may hinder liver regenerative capacity. Standard pre-operative assessments fail to accurately capture factors such as CALI and future liver remnant (FLR) function. The CLiFF and CoNoR studies utilise two novel assessment techniques, aiming to improve patient outcomes. Method The CLiFF study prospectively assesses two primary outcomes in 35 patients undergoing pre-operative chemotherapy for CLM: 1) change in liver function (via LiMAx test: direct assessment of hepatic functional capacity), and 2) change in liver fat (via advanced MR imaging (in-house spectroscopy and modified Dixon technique, scaled up via Perspectum LiverMultiScan)). The CoNoR study assesses potential added benefit...