Background: s/Aims: Postoperative pancreatic fistula (POPF) remains a significant complication following pancreatoduodenectomy (PD). It has been hypothesized that single loop (SL) reconstruction may increase the risk of POPF, leading to the proposal of double-loop (DL) reconstruction. In this approach, the pancreatic duct is connected to an isolated loop of bowel in a Roux-en-Y configuration. Methods: We conducted a retrospective multicenter study to compare various types of reconstruction after PD, analyzing data from 1,502 patients who underwent open, laparoscopic, or robotic PD across 28 centers worldwide. Propensity score matching (PSM) was applied to enhance comparability. Results: The overall rate of POPF was 34.89%, with a grade C POPF rate of 4.26%. The type of reconstruction (SL vs. DL) did not significantly impact the rates of POPF or grade C POPF, both before and after PSM. The rate of delayed gastric emptying (DGE) was 20.71%, and patients with DL reconstruction had a lower incidence of DGE both before and after PSM. Conclusions Our study found no significant differences in the risk of POPF between SL and DL reconstruction. However, DL reconstruction is associated with a reduced risk of DGE, suggesting it may be a preferable option following open PD.

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic.